FYIThe Brain-Gut ConnectionWhy do we get butterflies in our stomach before a performance?Why does indigestion produce nightmares?Why are antidepressants now also being used for gastrointestinal ailments?It turns out that both our gut and our brain originate early in embryogenesis from the same clump of tissue which divides during fetal development. While one section turns into the central nervous system, another piece migrates to become the enteric nervous system. Later the two nervous systems connect via a cable called the vagus nerve -- the longest of all the cranial nerves whose name is derived from Latin, meaning "wandering." The vagus nerve meanders from the brain stem through the neck and finally ends up in the abdomen. There's the brain-gut connection.Have you ever wondered why an impending job interview can cause an attack of intestinal cramps? And why do anti-depressants targeted for the brain cause nausea or abdominal upset in millions of people who take such drugs? The reason for these common experiences is because each of us literally has two brains --the familiar one encased in our skulls and a lesser-known but vitally important one found in the human gut. Like Siamese twins, the two brains are interconnected; when one gets upset, the other does, too. No wonder people trust their gut. One half of all our nerve cells are located within the gut?The state of the gut has a profound influence upon our health. It is from the healthy gut that we enjoy neurological and psychological as well as immunological health. This is not to discount the human brain. This is simply to say that the body has two brains -- the second brain being our gut. There is an excellent article on this brain-gut connection called Complex and Hidden Brain in Gut Makes Bellyaches and Butterflies written by Sandra Blakeslee, originally published in the January 23, 1996 issue of The New York Times. I have added a link to her article in the Diet section of the Links page.How it all WorksThe gut's brain, known as the enteric nervous system (ENS), is located in sheaths of tissue lining the esophagus, stomach, small intestine and colon. Considered a single entity, it is packed with neurons, neurotransmitters and proteins that zap messages between neurons or support cells like those found in the brain. It contains a complex circuitry that enables it to act independently, learn, remember and, as the saying goes, produce gut feelings.In his book The Second Brain, HarperCollins 1998, Dr. Michael Gershon, a professor of anatomy and cell biology at Columbia-Presbyterian Medical Center in New York City, dubs the entire gastrointestinal system the body's second nervous system. "The brain is not the only place in the body that's full of neurotransmitters," says Dr. Gershon. "A hundred million neurotransmitters line the length of the gut, approximately the same number that is found in the brain..." If we add the nerve cells of the esophagus, stomach and large intestine, there are more nerve cells in the gut than there are in the entire remainder of the peripheral nervous system. Nearly every chemical that controls the brain in the head has been identified in the gut, including hormones and neurotransmitters.This complex circuitry provides the brain in the gut with the means to act independently. Proof of this can be seen in stroke victims whose brain stem cells, which control swallowing, have been destroyed. If this occurs, a surgeon has to create an opening in the abdominal wall, so that feeding can be accomplished by manually inserting foods directly into the stomach. Once the food is in the stomach, digestion and absorption can take place, even in individuals who are brain dead. The central nervous system is needed for swallowing and for defecation, but from the time the food is swallowed to the moment its remains are expelled from the anus, the gut is in charge.The Sleep-Gut ConnectionAs light is shed on the circuitry between the two brains, researchers are beginning to understand why people act and feel the way they do. The brain and gut are so much alike that during our sleeping hours, both have natural 90-minute cycles. For the brain, this slow wave sleep is interrupted by periods of rapid eye movement sleep in which dreams occur. For the gut, the 90-minute cycles also involve slow waves of muscle contractions but, as with REM intervals, these are punctuated by short bursts of rapid muscle movement. Could it be that both brains influence each other? The answer is probably yes. REM sleep is a sleep phase characterized by arousal, altered activity of the autonomic nervous system and altered colon (large intestine) function.We also know that patients with bowel problems tend to have abnormal REM sleep. Poor sleep has been reported by many perhaps a majority of, patients with irritable bowel syndrome (lBS) and non-ulcerative dyspepsia (also known as "sour stomach") who complain of awakening tired and unrefreshed in the morning. Even after patients awake from what they describe as a "sound sleep," they report a general feeling of tiredness and fatigue.Abnormal REM sleep is reduced by low-dose treatment with the anti-depressant amitryptiline, which has also been shown to be effective in treating lBS and non-ulcerative dyspepsia. Many drugs designed to affect the brain also affect the gut. For example, the gut is loaded with the neurotransmitter serotonin. In fact, more serotonin is produced there than anywhere else in the body. Serotonin is linked with initiation of peristalsis.The Anxiety-Gut ConnectionAbout 25% of people taking fluoxetine (Prozac) and other types of similar-acting antidepressants experience gastrointestinal problems such as nausea, diarrhea and constipation. The problem with these drugs is that they prevent uptake of serotonin by cells that should be using it. While this enables the depressed person to have more serotonin in the brain, less is available for use by the cells of the gastrointestinal tract. "Serotonin is calming to the digestive tract, initiates peristaltic and secretory reflexes," notes nutritionist June Butlin, M.Sc., Ph.D. "Long-term use or the wrong dosage may cause fluctuations between nausea, vomiting, constipation and diarrhea, and can cause depression, anxiety, insomnia, and fluctuations in appetite."In a study reported in The New York Times article, Dr. Gershon and his colleagues explain Prozac's side effects on the gut. They mounted a section of guinea pig colon on a stand and put a small pellet in the 'mouth' end. The isolated colon whips the pellet down to the 'anal' end of the column, just as it would inside an animal. When the researchers put a small amount of Prozac into the colon, the pellet "went into high gear," Dr. Gerhson explained to the paper. "The drug doubled the speed at which the pellet passed through the colon, which would explain why some people get diarrhea," the paper says. No wonder, in small doses, Prozac is used to treat chronic constipation.Although a little is beneficial for constipation, a lot is not. When the Gershon team greatly increased the amount of Prozac in the guinea pig colon, the pellet stopped moving at all. Hence, a little cures constipation; a lot causes it. Prozac stimulates sensory nerves, thus can also cause nausea.The gut has opiate receptors much like the brain. "Not surprisingly, drugs like morphine and heroin that are thought to act on the central nervous system also attach to the gut's opiate receptors, producing constipation," notes pain management specialist Michael Loes, M.D., M.D.(H.), author of The Healing Response (Freedom Press 2002) "Both brains," he says, "can be addicted to opiates."Many Alzheimer's and Parkinson's disease patients are constipated. A sickness we think of as primarily affecting the brain or central nervous system also impacts the gut.Our gut also helps us in some amazing ways. The gut also produces chemicals called benzodiazepines. These are the same chemicals found in anti-anxiety drugs like Valium, and these are the same chemicals that alleviate pain. Perhaps our gut is truly our body's anxiety and pain reliever. While we are not sure whether the gut synthesizes benzodiazepine from chemicals in our foods, bacterial actions, or both, we know that in times of extreme pain, the gut goes into overdrive, delivering benzodiazepine to the brain. The result is to render the patient unconscious or at least reduce the pain, says Dr. Anthony Basile, a neurochemist in the Neuroscience Laboratory at the National Institutes of Health in Bethesda, Maryland.A Bit of BackgroundThroughout the world's healing and mystical traditions, the belly is seen as an important center of energy and consciousness. You've probably noticed that many of India's great spiritual adepts sport prodigious bellies. These tremendous tummies are thought to be full of prana. Hence, Indian artists often depict their deities with a paunch.In China, the gentle art of tai chi emphasizes the lower abdomen as a reservoir for energy. Tai chi teacher Kenneth Cohen, author of The Way of Qigong (Ballantine Books 1997), explains that it's possible to strengthen the abdominals by learning how to compact qi (prana) into the belly. "From the Chinese viewpoint," he says, "the belly is considered the dan tian or 'field of the elixir,' where you plant the seeds of long life and wisdom."Lastly, in Biblical times, the seat of emotion, which we call the heart, is actually referring to the bowels. That thought in itself conjures up an image of a young Romeo sending a love note to his Juliet saying, "You move me."In all seriousness, most people today completely ignore gut health. As a result, they are experiencing health problems that could be overcome if they knew that they centered in their gut. So I guess the thing to remember is, as Dr. Gershon puts it, "Take care of your gut and your gut will take care of you."Notes taken from, Patient Heal Thyself by Jordan S. Rubin, NMD, CNC
The brain-gut connection
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So are you saying Prozac should not be used to treat IBS? I just got prescribed Prozac one week ago and my symptoms have improved tremendously. I am IBS-D and I feel a lot better since I started taking it. I started at 10mg and just last night upped it to 20mg. So do you think this will be bad for me in the long run? Thanks for your advice.
mandsu815, Prozac can be used to treat IBS, so no I am not saying its a bad thing and your doctor prescribed it for you.They use the drugs also at low doses for pain in IBS.I was on it for IBS in the past, but had trouble with the way it made me feel and some side effects from it, but most side effects usally go away after a month. With me some of it was the way it made me feel neither up or down and foggy all the time. When I first started it it worked quite well, but that stopped for me after about six months.If its working great.One thing to know is the body can/may get use to it long term and then it may not be so effective. I would not rely on it as the only long term anagement for that reason personally if its just for IBS. Thatt's my honest opinion.All of our chemical makeups are different however, so it may keep working for you and if it is now great. This is something to discuss with your doctor, approaches for long term management. When I learned about what they do and how they work, I put more effort into learning natural ways and approaches to manage my IBS long term, that can work in some of the same ways the meds do.I personally am not anti drugs for IBS, but over the thrity years I have had IBS I have taken a ton of them with little to no success and felt like a medicine cabinet. The sheer frustration of nothing helping was no so good either. I think some of the drugs were also creating some of the problems I was having as well.I personally really believe that some natural approaches should be first before drugs or combined with them for better results long term.
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Dear mandsu815,If the Prozac is working for you, I would keep right on taking it. There are many different approaches to treating IBS-D--which might also be called chronic diarehha--and anti-depressants/anti-anxiety drugs are one. I'm taking Xanax, which stopped six months of daily D in 48 hours, and also taking Effexor which is anti-depressant/anti-anxiety. I just checked the Prozac site, and it too is used for both depression and anxiety. So if it is working for you, stick with it. There are a number of people on this site who for some reason are unwilling to consider those types of medication, but to each his own. Take care.
Here is some info on them for IBS.The Use of Antidepressants in the Treatment of irritable Bowel Syndrome and Other Functional GI Disorders http://www.med.unc.edu/wrkunits/2depts/med...sentsandibs.htm
This puts me in mind of a poster I remember from my college days (Oh God, 30 years ago!). It concerned an argument between the major organ systems of the body as to who was boss. To put it delicately, the winner proved to be just south of the gut!Seriously, though, the brain-gut connection makes a lot of sense. See also The Mindbody Connection by Dr. John E. Sarno.
ERIC!
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So glad to see you here! Folks, if you are reading these posts, trust me, Eric will help you with all good intentions. He has helped me so much that my quality of life has improved 98%, and that is saying a lot! I read all his previous posts on the brain-gut connection and took his advice, and now I'm able to get out and go places I never dreamed I would be able to. When you see his posts, heads up! He knows his stuff.
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sorry eric i'm not long a member here so i dont know what your symptoms for ibs are. so what is it that has helped your ibs condition if not any meds? did you have any anxiety problems?i'm seeing my doctor tomorrow and i'm thinking of mentioning going on anti-depressants like prozac to him. ya see along with my ibs-d symptoms i suffer with real bad anxiety. when my anxiety is bad my ibs-d symptoms go out of control. i love your brain gut connection theory cause for me thats exactly how it feels. i would often use the expression its like my gut has a mind of its own.my ibs-d symptoms in relation to food are probably quite minor in comparision to alot of people on this board mainly gas, cramps & pains, urgency, loose stools and occasional D, but its when the anxiety kicks in i suffer all the usual symptoms of anxiety, heart pounding, lack of concentration and focus, nervous shakes, face twitch etc plus the ibs-d symptoms go out of control.i really feel my symptoms are 65% anxiety 35% food intollerance & diet related. if i could just control this terrible anxiety then maybe i'd be close to bein cured.like you i dont like the idea of taking drugs for everything, i'd much prefer the body to repair itself. as my chinese herbalist once said to me "we are all made of the same stuff" so there is no reason why one has to keep suffering with anxiety whilst another leads an anxiety free life. i really believe the body has the power to repair itself. whilst having an anxiety attack i try so hard to tell myself to relax there's nothing to worry about, but its just too overpowering and i cant control it.the one drug which has helped in extreme anxious nervous situations for me is inderal. seems to work very quickly and stops the heart pounding and most other anxiety symptoms. dont even like the idea of taking this every day which i dont yet. also heard of some bad side effects of prolonged use of inderal, sex drive etc. but i really wanna sort out this anxiety problem so when i go back my doctor tomorrow i may just get him to put me back on inderal and try taking it every day to help with my anxiety rather than going on an anti-depressant. any feedback or suggestions eric?
matrixd, my story is here although you can't really express in words thirty years of suffering with IBS as it goes deeper then words can express . It was the first post added to that section really. It has now been over three years since I worte it on the bb here.I will copy it here.Ponderings of an IBSer eric Senior Member Member # 914 posted 01-09-2001 02:16 AM --------------------------------------------------------------------------------I was just thinking of expressing some of my thoughts on IBS and having it for thirty years. I have pain predominate IBS and alternating C and D. Although I can say had and really mean it,as I am doing so much better at about(85%) and I believe still improving thanks to this BB and Mike's tapes. I believe my IBS started from a trip to Mexico where I swallowed a small amount of cloroinated water out of a swimming pool and a half hour later, I was very sick with ameobic dysentary and spent the next month seriouly close to death. No Joke. They also pumped tons of penicillin into me at this time. However, ameobic dyentary is known to cause inflammation in the digestive tract. I recovered from that and I don't remember when or how soon I came back from Mexico, I was suffering from severe abdominal pain and alternating c and d.It wasn't to long before they started the first tests on me and that that testing would continue on and off for a big part of my life and cost thousands of dollars.The first tests were stool samples and upper gi tests all negative. The next test was a lower gi, also negative. Blood tests and all the regular tests from a normal MD. I was ten. In those days no one had a clue about IBS and they called it spastic colon or nervous stomach.I missed a lot of school and was always trying to catch up in my school work.Since the good doctors couldn't figure it out,I was sent for therapy and put on librium and told it was phycosomatic.I struggled for years through school,some working and trying to explain to friends why I was in pain alot and could not do things. Dating was a problem. They thought I had a stomach ache and it would go away and I should just quite being a big baby. Funny because my boss said that to me also, ten years later as well as a lot of coworkers.More testing. Basically the same kinds of tests over again. When your in your teens and your seeing some upstate NY md in a small town in those days testing didn't amount to much.Still no advise from anyone on what to do.My parents were very supportive and my mom is a nurse, which was very helpful and supportive. However,sometimes my moms own concern bothered me as she could not help and I could see that in her eyes while I layed there in complete agony from the knife jabbing sharp pains coming from my gut. When I got these pains I would hyperventilate and all kinds of thoughts raced through my head.For me this was already establishing itself into my thought patterns on a day to day basis's and I didn't really know much about living any other way as I hit my late teens. I was having episodes at least two to four times a week and that continued until I join this bb two years ago, although I would have some remissions they always came back and for a while my IBS went cyclic and bothered me most in the winter months, but in the summer improved somewhat. But it came back.Meanwhile, I continued to try to figure some of it out for myself, in ways I could manage it or do things to reduce it. Late teens to late twenties. More tests. "Maybe an ulcer,but we don't see it." New drugs, and from there librax, donnatol,prescription tagament,and a few others I don't even remember, but prozac was one as well. No noticable long term improvement. Mid thirties. I got serious and went to the best GI doc in town and told him to test away on everything we could think of that might be applicable. Also worried it could be something else still, although nothing showed up before he tested me and after he tested me. More drugs. Bentyl and valium. Sent to therapy told to relieve stress. I knew this wasn't the cause and thought because the pain was so severe that something had to be wrong in there, it just couldn't be possible to have this much pain and not have something physically that they could see wrong. I just didn't get it. I did know stress agravated it but not to the extent I do now or the kinds of stress either environmental, physical,or phychological and at the time I did not know how to reduce it enough with the management tecniques I was using and I used a lot of them. I tried all the food aspects and nothing other then some common sense on most things. Although it made sense what was going in had something to do with it, but in reality looking back now, it was common sense issues of eating to much to fast,fat,spices ect. etc..There were some weird signals before an attack. My skin would turn whiter, my eyes would twitch and my hands would sweat. Sometimes I woould get dizzy.My therapist had migranes and knew nothing about IBS, other then realizing some of the symptoms sounded somewhat like some symptoms she would get with her migranes and that it was not in my head (phycosomatic or crazy) and I should go back to the doctor. It wasn't helping me to see her so I agreed. Although she didn't explain serotonin to me, nor did my doctor take the time to either. I feel if someone would have explained some of the mind-gut connections earlier I could have save a lot of time and effort. I know some are realitively new, but I think they had some idea and either it was to complicated to explain to me or they just didn't have the time. I think at this point one of the best things a doctor can do is explain some of this to new patients. I didn't have any other issues I was healthly otherwise and was playing soccer for twenty years and going professional until I blew my kneecap out.I believe I personally have a classic case of IBS. For me I believe it is faulty neurotransmitters that are not talking right between my brain and my gut.Just some thoughts and thank god for hypnotherapy, which I want to add some of my thoughts on as a side note. Of course most people know I work with Mike now, but some probably do not. After meeting him on the bb here and the success I had I decided to work with him as I feel he has one of the most effective treatment tools for IBS. I am drug free and very happy with the results.I want to say something about hypnotherpay in general and what I believe and have seen for myself and these are my own personal comments from my experiences with it. Although, many others feel the same way now.It is the deepest from of relaxation I personally have ever found.It has tremendously reduced the pain for me from severe to very mild. I think this has worked two ways. It has steered my thoughts and attension away from the pain when I want and I also believe the relaxation aspect of it is releasing endorphines to my gut. This has been a big achievement and will save me trips to the ER.When I wake up in the morning I no longer have IBS on my mind first thing.I no longer dwell on it.I don't worry to much about going out or bathrooms any more.I know longer turn white or have my hands sweat.I can relax my gut at will.My whole body is more relaxed in general and I didn't realize how tense it was before.I breath better and more deeply. Which I have found useful if I feel any twinges of a potential problem.I sleep better and more deeply.Day to day problems don't bother me like they use to.I can eat things I couldn't before.I feel like I have beeen rewired so to speak.My BM's have improved substantially.There are symptoms I don't even remember and that is unbelievable.Anyway just some thoughts of an IBSer pondering.I don't know if this helps anyone and I also don't want to say hypnosis is a cure or the only thing people should be doing to manage IBS, but it is one majorally effective tool that isn't understood by a lot of people or used enough by doctors in the IBS world and why I sound like a broken record sometimes. However, I hope no one gets tired of hearing about something that really works for the majority of people with IBS as there are just to few of the things that do. http://www.ibsgroup.org/ubb/ultimatebb.php...c;f=17;t=000002 I have now learned way more about IBS.Clincal Gut directed or gut focused or gut directed HT has helped me more then I can express still.The forum for HT/CBT is gone at the moment however.Both these treatments have found to be effective for IBS on global symptoms.Here is some info. http://www.aboutibs.org/Publications/HypnosisPalsson.html http://www.ibshypnosis.com/IBSresearch.html http://www.aboutibs.org/Publications/hypnosis.html http://www.med.unc.edu/medicine/fgidc/hypnosis.htm The ones I used are here. http://www.ibsaudioprogram.com They have been very successful to a lot of people on the bb here as well as myself. http://www.ibsgroup.org/ubb/ultimatebb.php...c&f=11&t=000017 http://www.ibsgroup.org/ubb/ultimatebb.php...c&f=11&t=000433 Hope this helps matrixd. If you have any questions let me know, you also don't have to have phycological problems for it to work, just IBS.
Thank you Eric for posting this, it makes total sence to me and I will be researching it more. Diet does not seem to make a difference for me, but anxiety does. I have kept a food diary and found that what was fine yesterday will cause problems today,and be fine tomorrow, also the things everyone says to stay away from, sooths my tummy, such as Pepsi and milk. Go figure. I believe I have nerve damage in my digestive system due to deep depression and major stress over a 2 1/2 year period. glo
Glo, your welcome. This is on foods and IBS. http://www.ibshealth.com/ibs_foods_2.htm http://www.ibshealth.com/ibsfoodsinfo.htm The symptoms of d and c and alternating d/c. I have to state however, that IBS is majorally complex and they don't have all the answers to it yet. Also don't run out and try 5htp supplements as that is not really the problem, its how it circulates in the body, not the amounts. They are learning however mechanisms that cause symptoms, but they still don't have the whole picture figured out yet.FYIPathophysiologyAltered Serotonin Signaling?The pathogenesis of IBS remains obscure, and in particular, an explanation for alternating diarrhea and constipation has been elusive. In arguably one of the most important papers presented during this year's meeting, Moses and colleagues 21 studied potential deregulation of the gut's serotonin transporter in IBS. It is known that serotonin 5-hydroxytryptamine or 5HT is released from enteroendocrine or enterochromaffin cells in response to either chemical or mechanical stimulation of the gut mucosa. Serotonin in turn initiates peristalsis, and then the serotonin released is taken up in health by a highly selective serotonin transporter SERT. One potential mechanism that could explain altered bowel function in IBS is an abnormality in the serotonin transporter itself. The study authors evaluated this hypothesis in patients with IBS with constipation and IBS with diarrhea compared with patients with ulcerative colitis and healthy controls. They were able to convincing show on blinded review that SERT immunoreactivity was less intense in patients with IBS with constipation and patients with ulcerative colitis. If these findings are indeed correct, they represent a landmark observation. The findings suggest that patients with constipation and IBS may have a reduced capacity to reuptake serotonin, leading to excess free serotonin and then desensitization of these receptors, thus reducing motor function. In contrast, in the setting of diarrhea, serotonin uptake was normal. If the underlying abnormality in serotonin transporter function alternated, then this would in turn explain alternating constipation and diarrhea. These data strongly suggest that IBS is a "real" gut disease and a potential diagnostic disease marker. They also suggest that it is valid to subdivide IBS into constipation and diarrhea symptom subgroups. This study also provides additional rationale for the use of serotonin-modulating agents in IBS and provides a new target for drug modulation. Confirmation of these very exciting initial findings in larger patient samples is awaited with great interest.www.medscape.comThis was a question someone sent in to ask the harvard website, but it explains the pressure sensitve cells in the gut and some good info.Ask The Expert.Image of a cadeusus. .General Medical Questions.Q: I have suffered from irritable-bowel syndrome for many years. I get diarrhea. The doctors I've seen have offered little help. Recently, my daughter suggested I try an over-the-counter medicine called "5-Hydroxy-tryptophan," made by a company called Natrol Inc. My daughter says it is a mild antidepressant. It seems to have helped quite a bit, but it also seems to slow me down and make me feel tired. Can you give me any information on this? What is it, exactly, and are there any serious side effects? The only other medicine I take is Synthroid....The Trusted Source..Harold J. DeMonaco, M.S.Harold J. DeMonaco, M.S., is senior analyst, Innovative Diagnostics and Therapeutics, and the chair of the Human Research Committee at the Massachusetts General Hospital. He is author of over 20 publications in the pharmacy and medical literature and routinely reviews manuscript submissions for eight medical journals...June 19, 2001.A:Irritable bowel syndrome is now recognized as a disorder of serotonin activity. Serotonin is a neurotransmitter in the brain that regulates sleep, mood depression, anxiety, aggression, appetite, temperature, sexual behavior and pain sensation. Serotonin also acts as a neurotransmitter in the gastrointestinal tract.Excessive serotonin activity in the gastrointestinal system enteric nervous system is thought to cause the diarrhea of irritable-bowel syndrome. The enteric nervous system detects bowel distension expansion on the basis of pressure-sensitive cells in the bowel lumen opening. Once activated, these pressure-sensitive cells promote the release of serotonin, which in turn promotes both secretory function and peristaltic function the contractions of the intestines that force the contents outward. At least four serotonergic receptors have been identified to be participants in the secretory and peristaltic response.Patients with diarrhea-predominant IBS may have higher levels of serotonin after eating than do people without the disorder. This recognition led to the development of the first drug used specifically to treat diarrheal symptoms of IBS, alosetron also known as Lotronex. Alosetron blocked the specific serotonin receptors responsible for recognizing bowel distention. In doing so, it blocked the effects of serotonin and reduced both bowel secretions and peristalsis. Constipation was the most common side effect seen. Note: Alosetron was removed from the market by the manufacturer after repeated reports of a dangerous condition known as ischemic colitis became known. Tegaserod Zelmac is another drug under development and under review by the U.S. Food and Drug Administration for approval. Tegaserod is indicated for the treatment of constipation-predominant IBS and works to increase enteric nervous system serotonin activity.So, increasing serotonin activity in the enteric nervous system produces increased bowel secretions and peristalsis and potentially diarrhea, whereas depressing serotonin activity produces reduced secretions and reduce peristalsis and potentially constipation. Increasing serotonin activity in the brain would increase awareness and, in higher doses, produce anxiety, insomnia and restlessness. So I would have expected exactly the opposite effects of those that you experienced.I am unable to identify any possible drug interactions between 5-HTP and Synthroid levothyroxine but the symptoms described suggest a check with your doctor may be in order. Persistent feelings of tiredness and constipation may be signs of an underactive thyroid hypothyroidism.June 19, 2001 Harvard Health
This is some more on it all, but again it is super super complex. It is also being more recognized that chronic stress/stressorsors may play a major role.The Pharmacogenomics Journal 2003, Volume 3, Number 2, Pages 64-66 Irritable bowel syndrome genophenomics: correlation of serotonin-transporter polymorphisms and alosetron responseE Scherl and C L Frissora Division of Gastroenterology and Hepatology, The Weill Medical College of Cornell University, The New York Presbyterian Hospital, New York, USA Abstract The most significant medical advances have unmistakable genetic components,1 ranging from disease susceptibility to diversity in therapeutic response. Modern medicine's genetic emphasis is evident through clinicians' attempts to translate particular genotypes into clinical phenotypes, ever hopeful that in the near future selection of therapy will be based on a patient's genetic background. The basis of this new correlative science is predicated on the idea that genetic heterogeneity may allow physicians to tailor individual therapy, and therefore maximize clinical benefits while minimizing toxicity and cost. The human genome is 99.9% identical in all individuals. Individual differences are determined by only 0.1% of the genome.2,3 This very small fraction of the genome, which expresses polymorphisms, is responsible for disease susceptibility and therapeutic response. These genetic polymorphisms may influence clinical phenotypes. Camilleri et al4 propose that genetic polymorphisms at the serotonin-transporter (SERT) promoter influence response to a serotonin (5-HT3) antagonist in diarrhea predominant irritable bowel syndrome (D-IBS) patients and may affect the risk-benefit ratio with this class of compounds. IBS is a constellation of symptoms, varying from abdominal pain, discomfort, bloating, dyspepsia, to altered bowel habits. IBS is a leading cause of lost productivity at work. These symptoms affect upwards of 15% of the adult population, and many of these patients are women.5 D-IBS is characterized by accelerated small bowel and/or colonic transit as well as visceral and specifically rectal hypersensitivity. Neural influences on gut motility provide a mechanism by which an individual's neurotransmittters such as serotonin might influence gut function in D-IBS. The etiology of IBS remains obscure, but dysmotility related to interaction of molecules nitric oxide and neurotransmitters serotonin, as well as interactions between the brain and the gut, are actively being investigated. Alterations in enteric nerves have provided a new understanding for gastrointestinal diseases. Hypertrophic pyloric stenosis, previously thought to be a structural disorder of defective pyloric relaxation, is actually a functional disorder because of a deficiency of nitric oxide synthase.6 IBS-like symptoms confound inflammatory bowel disease IBD-related symptoms, and the fact that up to 25% of IBS patients report the onset of symptoms after an infectious process,7 underscores the need to understand the pathobiology of postinflammatory gut dysfunction. Enteric nerves may have a dual function in postinflammatory gut function. First, activation of the gut immune system may disrupt normal gut motility, leading to common symptoms of diarrhea, cramping, and bloating.8 Second, neurotransmitters, particularly neuropeptides such as substance-P, possess proinflammatory properties that may perpetuate the inflammatory cascade.9 Molecular advances in our understanding of enteric neurotransmitters may help in stratifying structural from functional symptoms and allow clinicians to individualize current therapies as well as develop novel therapies.10 Medical therapy for D-IBS remains a challenge, often with suboptimal results. Alosetron, a serotonin receptor antagonist, is effective in relieving symptoms in D-IBS.11,12 Alosetron, the first drug approved for the treatment of IBS in women, is a serotonin 5-HT3 antagonist that works in the enteric nervous system to decrease motility and visceral sensitivity. It causes constipation in a dose-dependent fashion and was voluntarily withdrawn form the US market because of complications of constipation and ischemic colitis. Alosetron has recently been reapproved by the FDA and will be the first drug to be administered with a specific risk management plan. This is the first time a drug has been reintroduced after withdrawal from the US market. Alosetron was reapproved due to its remarkable efficacy in women with D-IBS. Proper patient selection is essential to maximize the safety and efficacy of alosetron. Pharmacogenomic testing may prove to be pivotal in patient selection of alosetron responders and in maximizing benefit and minimizing risk. SERT is a transporter protein that is responsible for the reuptake of serotonin from the synaptic space. Therefore, a highly efficient SERT will clear 5-HT from the synapse more rapidly. The more efficient the SERT, the less 5-HT remains in the synapse and the less alosetron is needed to block the 5HT3 receptor. Polymorphisms in the promoter synthesis of SERT SERT-P may affect responses to serotonergic medications. Camilleri et al4 investigate the hypothesis that DNA variations of the promoter region for the SERT influence colonic transit in D-IBS patients treated with alosetron, differentiating alosetron responders from nonresponders and improving suboptimal therapeutic response for D-IBS. The function of peptides is determined by the structure of their receptors. Serotonin is a pluripotent neurotransmitter with more than 20 receptor subtypes identified. The receptor structure varies from the 5-HT3 nonselective cation channel to the G-protein 5-HT receptor. The varied receptors and functions of 5HT allow it to control various aspects of gut motility and visceral nocioception, thereby modulating intestinal sensorimotor function. There is a family of serotonin receptors comprising at least seven subclasses, differentiated on the basis of molecular structure and function.13 Receptors for serotonin type 3 influence postprandial colonic transit, often resulting in abdominal cramping, urgency, diarrhea and high-amplitude colonic contractions in IBS patients. Alosetron, a 5-HT3 receptor antagonist, decreases abdominal pain and diarrhea in women with D-IBS.11,12 Alosetron was not as effective clinically in slowing colonic transit in men with D-IBS.14 Gender-related differences in pharmacokinetics of alosetron were not uniform and did not explain the differences in clinical efficacy or transit response,15 suggesting factors other than gender alone might be responsible in distinguishing alosetron responders from nonresponders. The new 5HT modulators display a spectrum of responses ranging from 5HT3 and 5HT4 agonist-induced increased motility, to 5HT3 and 5HT4 antagonist-induced decreased motility. Variability caused by gender, age, nutritional status, intercurrent illness, disease pathogenesis and severity significantly influences pharmacogenetic molecular testing, which has gained recognition as a pivotal component in distinguishing therapeutic responders from nonresponders. This correlation allows for targeted optimization of therapeutic strategies.16 Translating genetic heterogeneity into individualized biologic and clinical efficacy aids clinicians in predicting and maximizing therapeutic response while minimizing cost and toxicity. Genetic polymorphisms in drug-metabolizing enzymes, transporters and other drug targets such as receptors have confirmed significant heterogeneity among individual responses to both efficacy and toxicity.12 Genetic polymorphisms underscore the importance of observations that different patients metabolize and respond to medications differently and provide a potential mechanism to select therapeutic responders. Camilleri4 tested the hypothesis that DNA variations in the promoter region for the SERT SERT-P influence the response of colonic transit to 5HT3 antagonist in D-IBS. They isolated DNA from whole blood in 23 patients and identified the polymorphisms by polymerase chain reaction PCR-based fragment length polymorphism. The homozygous long polymorphism of the SERT-P was associated with greater biological and clinical response to alosetron, compared to heterozygous polymorphisms. The investigations were unable to correlate variability in SERT-P polymorphisms with gender-specific enhanced alosetron efficacy. Another limitation of the current study was that few of the patients had the short polymorphism, so that this group was under-represented. Future studies evaluating the role of short polymorphisms of SERT-P in gender-specific clinical responses of D-IBS to 5HT3 antagonists are required. Pharmacogenomic correlation of serotonin-transporter polymorphisms and alesotron response is a powerful research tool that may aid in stratifying individual variation in clininical response of IBS patients. ReferencesBarbour V, Kleinert S, Pound P. Lancet 2001; 358 Suppl: S1-S66. Article Sander ES, Linton LM, Birren B, Nusbaum C, Zody MC, Baldwin J. Initial sequencing and analysis of the human genome. Nature 2001; 409: 860-921. Article PubMed Venter JC, Adams MD, Meyers EW, Li PW, Mural RJ, Sutton GG. The sequence of the human genome. Science 2001; 291:1034-1051. Article Camilleri M, Atanasova E, Carlson P, Ahmad U, Taekimit, Viramontes B et al. Serotonin-transporter polymorphism pharmacogenetics in diarrhea-predominant irritable bowel syndrome. Gastroenterology 2002; 123: 425-432. Article Camilleri M, Northcutt AR, Kong S, Dukes GE, McSorley D, Mangel AW. Efficacy and safety of alosetron in women with irritable bowel syndrome: a randomized, placebo-controlled trial. Lancet 2000; 355(9209: 1035-1040. Article Vanderwinden J-M, Mailleux P, Schiffmann S, Vanderhaeghen J, DeLaet M-H. Nitric-oxide synthase activity in infantile hypertrophic pyloric stenosis. N Engl J Med 1992; 327: 511-515. Rodriguez LA, Rulgomez A. Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study. BMJ 1999; 318: 565-566. Tornblom H, Lindberg G, Nyberg B, Veress B. Full-thickness biopsy of the jejunum reveals inflammation and enteric neuropathy in irritable bowel syndrome. Gastroenterology 2002; 123: 1972-1979. Article Collins SM, VanAssche G, Hogaboam C. Alterations in enteric nerve and smooth-muscle function in inflammatory bowel diseases. Inflammatory Bowel Dis 1997; 3: 38-48. Scherl E. Irritable-inflammatory bowel diseases: recognizing a new overlap syndrome and an enigma wrapped inside a puzzle. Inflammatory Bowel Dis 2002; 8: 373-374. Camilleri M, Chey WY, Mayer EA, Northcutt AR, Heath A, Dukes GE et al. A randomized controlled trial of the serotonin type 3 receptor antagonist alesotron in women with diarrhea predominant irritable bowel syndrome. Arch Intern Med 2001; 161: 1733-1740. Article Drossman DA, Camilleri M, Mayer E, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology 2002; 123: 2108-2131. Article Kim D-Y, Camilleri M. Serotonin: a mediator of the brain gut connection. Am J Gastroenterol 2000; 95: 2698-2709. Article Viramontes BE, Camilleri M, McKinzie S, Burton D, Thomforde GM. Gender related differences in slowing colonic transit by a 5HT-3 antagonist in subjects with diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol 2001; 92: 2671-2676. Article Camilleri M, Mayer EA, Drossman DA, Heath A, Dukes CE, McSorley D et al. Improvement in pain and bowel function in female irritable bowel syndrome patients with alosetron, a 5HT3 receptor antagonist. Aliment Pharmacol Ther 1999; 13: 1149-1159. Article Evans WE, Relling MV. Pharmaco-genomics: translating functional genomics into rational therapeutics. Science 1999; 286: 487-491. Article PubMed
Here is the whole article the person above was writting about from the NY Times. It has more info.Complex and Hidden Brain in Gut Makes Bellyaches and ButterfliesEver wonder why people get "butterflies" in the stomach before going on stage ? Or why an impending job interview can cause an attack of intestinal cramps ? And why antidepressants targeted for the brain cause nausea or abdominal upset in millions of people who take such drugs ? The reason for these common experiences, scientists say, is that the body has two brains - the familiar one encased in the skull and a lesser known but vitally important one found in the human gut Like Siamese twins, the two brains are interconnected ; when one gets upset, the other does, too. The gut's brain, known as the enteric nervous system, is located in sheaths of tissue lining the oesophagus, stomach, small intestine and colon. Considered a single entity, it is a network of neurons, neurotransmitters and proteins that zap messages between neurons, support cells like those found m the brain proper and a complex circuitry that enables it to act independently, learn, remember and, as the saying goes, produce gut feelings.The brain in the gut plays a major role in human happiness and misery. But few people know it exists, said Dr. Michael Gershon, a professor of anatomy and cell biology at Columbia Presbyterian Medical Center in New-York. For years, people who had ulcers, problems swallowing or chronic abdominal pain were told that their problems were imaginary, emotional, simply all in their heads. Dr. Gershon said. They were shuttled to psychiatrists for treatment. Doctors were right in ascribing these problems to the brain. Dr. Gershon said, but they blamed the wrong one. Many gastro-intestmal disorders like colids and irritable bowel syndrome originate from problems within the gut's brain, he said. And the current wisdom is that most ulcers are caused by a bacterium, not by hidden anger at one's mother.Symptoms stemming from the two brains get confused. Dr. Gershon said. "Just as tlie brain can upset the gut, the gut can also upset the brain" he said. "If you were chained to the toilet with cramps, you'd be upset too." Details of how tlie enteric nervous system mirrors the central nervous system have been emerging in recent years, said Dr. Gershon, who is considered one of a new field of medicine called neurogastroenterology. Nearly every substance that helps run and control the brain has turned up in the gut. Dr. Gershon said. Major neurotransmitters like serotonin, dopamine, glutamate, norepinephrine and nitric oxide are there. Two dozen small brain proteins, called neuropepddes, are in the gut, as are major cells of the immune system. Enkephalins, one class of the body's natural opiates, are in the gut And in a finding that stumps researchers, the gut is a rich source of benzodiazepines - the family of psychoacrive chemicals that includes such ever popular drugs as Valium and Xanax. In evolutionary terms, it makes sense that the body has two brains, said Dr. David Wingate, a professor of gastrointestinal science at the University of London and a consultant at tlie Royal London Hospital. The first nervous systems were intubular animals that stuck to rocks and waited for food to pass by. Dr. Wingate said. The limbic system is often referred to as the "reptile brain". As life evolved, animals needed a more complex brain for finding food and sex and so developed a central nervous system. But the gut's nervous system was too important to put inside the newborn head with long connections going down to the body. Dr. Wingate said. O-ffsprmg need to eat and digest food at birth. Therefore, nature seems to have preserved the enteric nervous system as independant circuit. Inside higher animals, it is only loosely connected to the central nervous system and can mostly function alone, without insructions from topside. This is indeed the picture seen bydevelopmental biologists. A clump of tissue called the neural crest forms early in emblyogenesis. Dr. Gershon said. One section turns into the central nervous system. Another piece migrates to become the enteric nervous system. Only later arte the two nervous systems connected via a cable called the vagus nerve. Untill relatively recently, people thought that the gut's muscles and sensory nerves were vyired directly to the brain and that the brain controlled the gut through two pathways that increased or decreased rates of activity. Dr. Wingate said. The gut was simply a tube with simples reflexes. Trouble is, no one bothered to count the nerve fibers in the gut. When they did, he said, they were surprised to find that the gut contains 100 million neurons - more that the spinal cord has. Yet the vagus nerve only sends a couple of thousand nerve fibers to the gut. The brain sends signals to the gut by talking to a small number of "command neurons", which in turn send signals to gut intemeurons that cany messages up and down the pike. Dr. Gershon said. Both command neurons and interneurons are spread throughout two layers of gut tissue called the myenteric plexus and the subrnuscosal plexus. ("Solar plexus" is actually a boxing term that refers simply to nerves in the abdomen.) Command neurons control the pattern of activity in the gut. Dr. Gershon said. The vagus nerve only alters the volume by changing its rate of firing. The plexuses also contain glial cells that nourish neurons, mast cells involved in immune responses, and a "blood brain barrier" that keeps harmful substances away from important neurons. Dr. Gershon said. They have sensors for sugar, protein, acidity and other chemical factors that might monitor the progress of digestion, determining how the gut mixes and propels its contents. "It's not a simple pathway", he said. "It uses complex integrated circuits not unlike those found in the brain." The gut's brain and the head's brain act the same way when they are deprived of input from the outside world. Dr. Wingate said. During sleep, the head's brain produces 90-minute cycles of slow wave sleep punctuated by periods of rapid eye movement sleep in which dreams occur. During the night, when it has no food, the gut's brain produces 90-minute cycles of slow wave muscle contractions punctuated by short bursts of rapid muscle movements. Dr. Wingate said.The two brains may influence each other while in this state. Dr. Wingate said. Patients with bowel problems have been shown to have abnormal REM sleep. This finding is not inconsistent with the folk wisdom that indigestion can produce nightmare. As light is shed oA the circuitly between the two brains, researchers are beginning to understand why people act and feel the way they do. When the central brain encounters a frightening situation, it releases stress hormones that prepare the body to fight or flee. Dr. Gershon said. The stomach contains many sensory nerves that are stimulated by this chemical surge - hence the "butterflies". On the battlefield, the higher brain tells the gut brain to shut down. Dr. Gershon said. "A frightened, running animal does not stop to defecate", he said. Fear also causes the vagus nerve to "turn up the volume" on serotonin circuits in the gut. Dr. Gershon said. Thus overstimulated, the gut goes into higher gear and diarrhea results. Similarly, people sometimes "choke" with emotion. When nerves in the oesophagus are highly stimulated, people have trouble swallowing. Even the so-called "Maalox moment" of advertising fame can be explained by the two brains interacting, said Dr. Jackie D. Wood, chairman of the department of physiology at Ohio State University in Columbus. Stress signals from the head's brain can alter nerve function between the stomach and oesophagus, resulting in heartburn.In cases of extreme stress. Dr. Wood said, the higher brain seems to protect the gut by sending signals to immunological mast cells in the plexus. The mast cells secrete histamine, prostaglandin and other agents that help produce inflammation, he said. "This is protective. If an animal is in danger and subject to trauma, dirty stuff in the intestines is only a few cells away from the rest of the body. By inflaming the gut, the brain is priming the gut for surveillance. If the barrier breaks, the gut is ready to do repairs". Dr. Wood said. Unfortunately, the chemicals that get released also cause diarrhea and cramping. Such cross talk also explains many drug interactions. Dr. Gershon said. "When you make a drug to have psychic effects on the brain, it's veiy likely to have an effect on the gut that you didn't think about", he said. Conversely, drugs developped for the brain could have uses in the gut.For example, the gut is loaded with neurotransmitter serotonin. When pressure receptors in the gut's lining are stimulated, serotonin is released and starts the reflexive motion of peristalsis. Dr. Gershon said. Now a quarter of people taking Prozac or similar antidepressants have gastrointestmal problems like nausea, diarrhea and constipation, he said. These drugs act on serotonin, preventing its uptake by target cells so that it remains more abundant in the central nervous system.In a study to be published soon. Dr. Gershon and his colleagues explain Prozac's side effects ont the gut. They mounted a section of guinea pig colon on a stand and put a small pellet in the "mouth" end. The isolated colon whips the pellet down to the "anal" end of the column, just as it would inside an animal. Dr. Gershon said. When the researchers put a small amount of Prozac into the colon, the pellet "went into high gear". Dr. Gershon said. The drug doubled the speed at which the pellet passed through the colon, which would explain why some people get diarrhea. Prozac as been used in small doses to treat chronic constipation, he said.But when researchers increased the amount of Prozac in the guinea pig colon, the pellet stopped moving. The colon froze up. Dr. Gershon said, which is why some people get constipated on the drug. And because Prozac stimulated sensory nerves, he said, it can also cause nausea. Some antibiotics like crythromycin act on gut receptors to produce oscillations. Dr. Gershon said. People experience cramps and nausea. Drugs like morphine and heroin attach to the gut's opiate receptors, producing constipation. Indeed, both brains can be addicted to opiates. Victims of AIzheimer's and Parkingson's diseases suffer from constipation. The nerves in their gut are as sick as the nerve cells in their brains. Just as the central brain affects the gut, the gufs brain can talk back to the head. Dr. Gershon said. Most of the gut sensations that enter conscious awareness are negative things like pain and bloatedness. Dr. Wingate said. People do not expect to feel anything good from the gut but that does not mean such signals are absent, he said. Hence, the intriguing question : why does the human gut produce benzodiazepine 7 The human brain contains receptors for benzodiazepine, a drug that relieves anxiety, suggesting that the body produces its own internal source of the drug, said Dr. Anthony Basile, a neurochemist in the Neuroscience Laboratory at the National Institutes of Health in Bethesda, Md. Several years ago, he said, an Italian scientist made a startling discovery. Patients with their liver failure fall into a deep coma. The coma can be reversed, in minutes, by giving the patient a drug that blocks benzodiazepine. When the liver falls, substances usually broken down by the liver get to the brain. Dr. Basile said. Some are bad, like ammonia and mercaptans, which are "smelly compounds that skunks spray on you", he said. But a series of compounds are also identical to benzodiazepine. "We don't know if they come from gut itself, from bacteria in the gut or from food". Dr. Basile said. But when the liver falls, the gut's benzodiazepine goes straight to the brain, knocking the patient unconscious. The payoff for exploring gut and head brain interactions is enormous. Dr. Wood said. For example, many people are allergic to certain foods, like shellfish. This is because mast cells in the gut mysteriously become sensitized to antigens in the food. The next time the antigen shows up in the gut. Dr. Wood said ; the mast cells call up a program, releasing chemical modulators that try to eliminate the threat. The allergic person gets diarrhea and cramps, he said. Many autoimmune diseases like Krohn's disease and ulcerative colitis may involve the gut's brain. Dr. Wood said. The consequences can be horrible, as in Chagas disease, which is caused by a parasite found in South America. Those infected develop an autoimmune response to neurons in their gut. Dr. Wood said. Their immune systems slowly destroy their own gut neurons. When enough neurons die, the intestines literally explode. A big question remains. Can the gut's brain learn 7 Does it "think" for itself 7 Dr. Gershon tells a story about an old Army sergeant, a male nurse in charge of a group ofparaplegics. With their lower spinal cords destroyed, the patients would get impacted."The sergeant was anal compulsive". Dr. Gershon said. "At 10 A.M. eveiyday, the patients got enemas. Then the sergeant was rotated off the ward. His replacement decided to give enemas only after compactions occured. But at 10 the next morning, everyone on the ward had a bowel movement at the same time, without enemas". Dr. Gershon said. Had the sergeant trained those colons?The human gut has long been seen as a repositoiy of good and bad feelings. Perhaps emotional states from the head's brain are mirrored in the gut's brain, were they are felt by those who pay attention to them. The "brain in the gut" takes the form of two networks of neural connections in the lining of the gastrointestinal tract, called the myenteric plexus and the subrnucosal plexus. The nerves are highly interconnected and have direct influence on things like the speed of digestion, the movement and secretions of the finger-like mucosa that line the intestines and the contractions of the different kinds of muscle in the gut wall. [Diagram # 1] GUT-BRAIN HIGHWAY: A 2-WAY STREET:The gut has a mind of its own, the enteric nervous system. Just like the larger brain in the head, researchers say, this system sends and receives impulses, records and experiences and responds to emotions. Its nerve cells are bathed and influenced by the same nerotransmitters. The gut can upset the brain just as the brain can upset the gut. [Diagram #2]Diagram of wall of small intestine, with layers cut away to show two networks of nerves that make up enteric nervous system, or "brain in the gut". One network, called the subrnucosal plexus, is just under the mucosal lining. One, the myenteric plexus, lies between two coats of muscle. [Diagram # 3] Sandra BLAKESLEE, The New York Times, Januaiy 23rd, 1996.This is on Dr Gershons work with the enteric nervous system http://www.hosppract.com/issues/1999/07/gershon.htm
thanks for that eric. i never mentioned i once tried hypno for my general anxiety and confidence with amazing results. i went to a therapist about it and she hypnotist me there and then for a session. that was over 2yrs ago now and i still remember til this day how good i felt for the rest of that day. it was like a cloud had been just lifted from me.see gave me a recording of the session to listen to at home but after that session i was unable to get as far into a deep trance on my own as i did with that therapist. never the less i did feel like i was hypnotized. because i went into work feeling a new person. my social phobia practically disappeared, i was so confident around people its like i didnt care i was just gonna be myself and not afraid to say my feelings.inside it felt so good to no longer be afraid. and even people around me felt i was on happy pills so to speak. they were seeing a new person.but as time went on i felt it more difficult to listen to the tape every night and would get disturbed during a session. its also like my mind would wander during the tape like i was bored because i was hearing the same stuff over and over. eventually i was'nt feeling hypnotised anymore and stopped the tape.2yrs have passed and i have social phobia, ibs-d symptoms and just a memory of how i once felt great just by using the power of my mind. i guess i'm afraid to go for another session of hypno in the worry that it wont work this time and its seemed to be the one thing which has helped both my anxiety mainly and ibs symptoms. so i'm sort of leaving hypno as a last resort. also i would rather have a male therapist this time as i think alot of my anxiety is more with women. dont know why just seems to be worse around them. do you think mikes tapes alone without an actual therapist to talk to can work just as good? cause thats the main reason i have'nt went for them yet? are the tapes more ibs symptoms focused or anxiety cause as i said i think my main problems with ibs are anxiety and social phobia related? and finally i sent mike an email last month and he was on vacation is he back yet?thanks again
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