Parents of children with abdominal issues know that stomach pain, diarrhea, constipation and bloating are nothing to joke about. Each episode can be a major disruption to family life, exacerbating tensions and embarrassing an already anxious child.
If not handled with care, rumbling tummies often become chronic, progressing into functional gastrointestinal disorders such as irritable bowel syndrome, recurrent abdominal pain or dyspepsia. The term “functional” refers to disorders that do not have an identified pathological cause and may not show up on medical tests, but result in very real discomfort for sufferers. In their 2014 book, “The Gut Solution,” local gastroenterologist Dr. Michael Lawson and clinical psychologist Jessica Del Pozo team up to address the underlying emotional, neurological and behavioral factors that affect the digestive system.
Lawson and Del Pozo, who worked together at Kaiser Permanente in Northern California, were both seeing concerning numbers of adult patients suffering from IBS, a condition that affects 60 million Americans, or 20 percent of the population. They developed the SEEDS program (stress management, exercise, education, diet and sleep) for kids, in an attempt to nip IBS in the bud. After seeing real results with more than 400 children, they packaged the approach in a 100-page manual, complete with menus, illustrations and family conversation starters.
As April has been IBS awareness month, The Bee sat down with Lawson, the gut guru, and Del Pozo, the brain wiz, to discuss oatmeal, emotions and the virtues of electronic-free downtime.
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Q: From a mechanical standpoint, what’s going on in kids with functional GI disorders?
Lawson: It’s part of a big spectrum of two problems – one’s called visceral hypersensitivity, and the other is called poor accommodation. Visceral hypersensitivity makes these kids feel things at a lower threshold. If you were to put a balloon inside their stomach and pump it up, half the volume of the balloon would trigger the same discomfort as a full balloon would in someone else. And they don’t accommodate well. What that means is because their brains are on information overload, instead of relaxing they’re going tense. So take a balloon and try to blow it up inside a tin cup. There’s no give for gas or food or whatever has got to go somewhere. So that’s where they throw up or have diarrhea or bloat, because they’re trying to create some space.
Q: IBS has been shown to run in families, but it isn’t tied to a gene. It’s not a disease that shows up on a test, but can be diagnosed by looking at symptoms. So what causes it?
Del Pozo: It’s not just a genetic problem, it’s not just a psychological problem. It is, as most things are, a combination of brain and gut that we can’t separate.
Lawson: The condition is best explained by the brain-gut axis. There’s a pain gate, in what’s called the mid-brain, where everything goes through. ... In the case of patients with IBS, it’s like watching a bunch of cattle come through a small gate. If you open the gate, more cattle come through.
Del Pozo: Stress is one thing that opens that gate.
Q: You write that IBS most commonly occurs in children who feel pressured at school or at home. How do the emotions these children experience – fear of failure, anger, anxiety – wreak havoc on the gut?
Del Pozo: If you’re in fight-or-flight response, your body doesn’t want to sit down and digest food. It wants to deal with the impending doom or disaster it’s expecting or feeling. And it feels terrible. The stomach isn’t discerning the difference between a true catastrophe – an earthquake – and the lunch room. It’s just responding by saying you’re in a crisis, and I’m not going to relax and digest food.
Q: Traditional treatment for IBS can include multiple medications and even surgery. Your program includes group therapy, educational sessions for parents, and household changes in exercise, diet and lifestyle. Why does it work?
Lawson: Group therapy is very powerful, much more powerful than one-on-one interactions. And when the kids see other kids with the same problem – they look pretty cool, they look alright, they’re not dying – the kids feel like they’re not freaks.
Del Pozo: IBS puts up a battle in the family. Everyone’s organizing around the patient. And it’s a family problem, it’s not a person problem. Rather than look at there being something wrong with that child or needing to fix that child, look at the family unit and the dynamic that’s happening. Once we get them in the class, we can do even more by talking to their parents. Their being a role model can’t be downplayed. How they live, if they catastrophize the stomachaches, or if they ignore them, or if they return to the ER. Whatever the reaction is, they have to get real and look at how are they contributing to this cycle.
Q: What does your book say about diet?
Del Pozo: They can eat according to their symptoms, and that’s the best part of the menus (in the book). If you have pain it’s hard to know what to eat, but go for the soft foods, the applesauce and the oatmeal ... just very simple things in small amounts throughout the day to keep their energy up. Otherwise they wait till the end of the day, they overeat junk food, and then they feel rotten all night, and it starts again.
Lawson: The mornings are rough on the kids. So smoothies are good, they’re digestible. A lot of it’s common sense.
Q: What are some elements of a gut-friendly home?
Del Pozo: Quiet time together, with the family, that isn’t hurried. How your grandmother might have had the house – there’s music on, there might be candles. There’s downtime where people aren’t all plugged into their devices, they’re actually talking to each other, checking in. Just easy, regular playtime. Exercising could be mindful, it could be playful. Eating could be mindful, it could be playful. It doesn’t matter what you’re doing, but it matters how you’re doing each of these things. You’re staying connected that way, and having fun.
Q: What impact has your program, and the book, had so far?
Lawson: We’ve had moms in tears. Some say it’s the best thing that’s ever happened to their kid. Some say, “My kid’s been in counseling for two years, and in three hours you’ve done more than anyone’s ever done.” And even at four years (out), they’re still doing well. It’s not just a touchy-feely placebo effect. We’ve had a big impact on not just GI visits but GI imaging, and mental health visits going way down. From a financial point of view, we save an absolute fortune. We spend $90 for one kid to go through the program, and we save a future gazillion dollars on him. These kids are not going to be frequent fliers. They’re not going to be going to the doctor for everything.