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May/June 2007 Featured Stories
Rx for Panic Attack of the Gut

by Steven E. Hodes, M.D.

Steven E. Hodes, M.D.

Ever wonder why our gastrointestinal tract is considered the source of intuitive knowledge or wisdom? And why so many of us are plagued by seemingly random and at times incapacitating disturbances in that area?

The GI tract is actually one of the most aware parts of the human anatomy.

The Brain-Gut Connection

A traditional diagram of the gastrointestinal tract usually reveals the organs -- esophagus, stomach, small bowel and colon ? but what's often left out are the nerve bundles or plexus (the centralized collection of neurons that are smaller yet analogous to the Hindu notion of chakras) and the enteric nervous system. These make up the brain in the gut.

With as many nerve cells or neurons as the entire spinal cord, the gut evolved prior to the development of our pre-frontal cortex. This means that our vertebrate and mammalian ancestors had a brain-gut connection before they had a brain and conscious mind as we know it. A look into our ancient past shows how emotional states may exist below the level of our own conscious awareness and can cause profoundly disturbing physical symptoms.

Psychoneuroimmunologist Candace Pert PhD has referred to the body as the subconscious mind. Besides the direct neural, hard-wired pathways, there is the emotion-induced blood-borne release of peptides that bind to serotonin receptor sites in the cells lining the gut.

As humans, we have evolved to be able to deal with acute stresses. Our ancestors needed the fight or flight reaction to survive and protect them from perilous danger. But our minds have transformed this mechanism into the chronic, unremitting angst that many experience today. Often we never stop fearing, stressing or worrying. It is enough to give many people a pain in the belly.

Panic Attack of the Gut

Physicians have labeled the gut's response to this array of gastrointestinal symptoms as irritable bowel syndrome. Depending upon which section is affected, the symptoms can range from non-cardiac chest pain to swallowing difficulties, to nausea, to abdominal pain, bloating, cramping, diarrhea and constipation. But behind this assortment of symptoms there is, in its most severe form, a central theme called panic attack of the gut.

People who suffer from panic attack of the gut can learn to respond to the bowel symptoms by exploring their underlying and subconscious emotional issues. Keeping them bottled up just does not work. That angst has to be released somewhere, and the colon often becomes a dumping ground.

I have no doubt that more serious gastrointestinal disorders such as Crohn's Disease, ulcerative colitis, peptic ulcer disease and perhaps cancer have strong psycho-physiologic components as well. Irritable bowel syndrome (IBS), however, is much more prevalent, affecting nearly 20 percent of the population, and negatively impacting work productivity at $60 billion annually.

Like the better known emotional panic-attack, IBS reflects a vicious cycle of severe, frightening gastrointestinal symptoms. Attacks of abdominal pain, bloating, nausea and episodes of uncontrollable diarrhea may be so incapacitating as to render patients fearful to venture out of their homes. Tragically by climbing a mountain of worry, they only worsen their condition.

Bring Healing to Your Gut

When my patients are suffering from a panic attack of the gut,I use many methods -- classic therapies such as such as adding fiber or using anti-spasmodic medications, prescribing medications to be carried along and taken only when the attack begins, education and awareness of specific dietary triggers.

I also focus on supporting their mental and emotional health, and offer a holistic technique to ward off a panic attack of the gut.

1. Pre-emptive strike. Anticipate the circumstances under which you usually get sick. For some diet is extremely important and individual food intolerances can mimic or worsen these attacks. Be aware of lactose, spices, gluten, artificial sweeteners as well as a host of personal idiosyncratic reactions to ingested agents. Also recognize the symptoms early. Take whatever medication you may be carrying with you. Realize that your mind and body are connected and that it is possible to direct your mind to send calming messages to your body.
2. Breathe. Begin a slow, rhythmic meditative breathing. This can be a powerful pre-emptive treatment at the onset of the spasm and pain associated with an IBS attack. It may trick the body into thinking you are relaxed - and the body will respond that way.
3. Positive affirmations. When you feel it coming on, tell yourself its okay, you will get through it, and to go with the attack. Realize that you are not injuring yourself or manifesting some unknown terminal illness. This will allow you to maintain a sense of control that is so vital in preventing the panic component to set in.
4. Visualize. Retrieve a memory of your most relaxed state of being. Were you on a warm beach, drifting in and out of consciousness? When you were most joyous? Bank such experiences and practice bringing them to conscious awareness when needed. Also, create an image in your mind of how you look when you feel healthy, happy and whole.
5. Give yourself a break. It is not going to be easy to change your body's basic reaction to stress. It takes time and practice. If you get frequent attacks before you leave the home, simply plan for it. Give yourself extra time if needed. If you worry about where the closest bathroom is when you go out, you can keep yourself aware in a calm manner. Disarm the situation and it will carry less power to make you sick.

Once you learn to manage the symptoms of this panic attack of the gut, you will find yourself better able to transform these episodes of suffering into opportunities for psycho-spiritual growth.

Steven E. Hodes, M.D. is a board certified gastroenterologist with over 25 years in private practice in New Jersey. He also has a degree in religious studies and teaches contemporary metaphysics at Brookdale College as well as lecturing and writing on Kabbalah. Visit his daily blog, Physician to Meta-Physician, at www.meta-md.com.