1 Jul 20220 Comments
If you’re suffering from digestive issues, maybe it’s time to relax.
What is commonly labeled a “holistic” or “whole patient” method of treating problems with initials like IBS, IBD or GERD is gradually becoming more mainstream. And for many people, an integrated approach that incorporates both medical and lifestyle solutions can lead to greater wellness and fewer problems with the gut.
Heather L. Klavan, MD, is a board-certified gastroenterologist at Northwell Health Physician Partners, and practices out of their White Plains office. Aside from regular screenings for colon cancer (recommended for anyone age 45 or older), most of her patients arrive in her waiting room with one of three major complaints: functional bowel disorders with symptoms that may suggest irritable bowel syndrome (IBS), presenting with constipation, diarrhea, bloating or abdominal pain; persistent heartburn that may have advanced to gastroesophageal reflux disease (GERD); or symptoms that may indicate inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis.
Gastrointestinal complaints have become all too common in adults. A 2017 study published in the Journal of Clinical Medicine found that functional gastrointestinal disorders (FGIDs)—defined as persistent and recurring GI symptoms not caused by tumors, masses or biochemical abnormalities, account for at least 40 percent of referrals to gastroenterologists. Klavan says there’s little evidence that GI problems go hand in hand with aging—something to be tolerated. “If an older person suddenly displays symptoms of IBS for the first time, it could be cause for concern,” she says. “Don’t blame it on age.”
To arrive at a diagnosis, Klavan relies on blood work, stool testing, imaging tests, and procedures such as endoscopy or colonoscopy. Once she’s pinpointed the pathology, treatment follows a three-pronged approach that incorporates medication, diet and lifestyle. She screens her patients for life stressors that may be causing anxiety or depression, and the interplay among them that can cause or exacerbate symptoms in the gut. Klavan sometimes prescribes low dose antidepressants to treat certain cases of IBS and functional bowel disorders. “There’s definitely a mind-body connection at work,” she says. Not that such disorders are psychosomatic. “If you’re having diarrhea 25 times a day, it’s not ‘all in your head.’ You’re not making it up.”
Asked to identify the single most important action a person can take to prevent or alleviate GI issues, Klavan answers without hesitation: “Improve your diet.” She ticks off strategies that will surprise no one: reducing fats, sugars and processed foods; eating less red meat and more plant-based proteins; and consuming plenty of fresh fruits, vegetables and whole grains. Before patients leave her office, Klavan often refers them to a registered dietitian to help navigate the recommended diet, address specific challenges, and adapt it to their lifestyle.
Jennifer Fox, RD, CDN, CDCES, a senior registered dietitian at Northwell Health Physician Partners, with offices in Sleepy Hollow and Katonah, frequently counsels patients referred by Klavan and other medical practices. “They’ll arrive at my office holding a paper handout from their doctor, not knowing how or where to begin,” she says. “They may have tried a thing or two but many feel overwhelmed.”
Fox takes her time with each patient, reviewing their diagnosis, medical history and lifestyle. First, she asks them to keep a diary of everything they’ve eaten for the past several days. With that, she can pinpoint areas for improvement and walk them through recommended steps. With those who balk—who wants to give up their favorite comfort foods?—she explains cause and effect between their diet and their current condition. She has seen remarkable improvements, such as the alleviation of constant diarrhea in one patient, and the reversal of unintentional weight loss in another.
Fox typically devotes several visits to each patient, sometimes working with them for up to a year or more. She helps them ease into healthier habits by introducing new products and meal ideas that help motivate commitment. “I try to find the least restrictive, most effective diet for each individual patient,” she says. “It has to be something they can sustain for the long-term.”
Both practitioners approach the role of stress in their patients’ lives in similar ways. Klavan recommends wellness practices and other integrative approaches that can benefit many functional GI disorders—from meditation to breathwork to mental health counseling. Fox encourages patients to re-examine any excessive demands being made on them: be it family, volunteering, work or other pressures that might be compromising their health.
“Once a patient commits to change, they start feeling so much better, both mentally and physically. They want to continue,” Fox says. “I have a lot of patients tell me they wish they’d come to see me years ago.”