"The pain's just a program."

I’ve been watching Season 2 of Westworld, which is currently being released in single episodes on Sunday nights. The sci-fi plot is fascinating in a semi-incomprehensible, deeply philosophical kind of way, which I love. But overall, the show is so horribly violent that every week I ask myself if I even want to keep watching.

Then I do.

In this week’s episode, one of the main characters needs to strap himself into a torturous device that will saw through his cranium, remove a circle of his bony skull cap and extract a small mechanism buried inside his brain, all while he is wide awake with no anesthesia.

Naturally the character is afraid of how painful this surgery will be, but it’s the only option, the world is at stake. As his head is being locked into position, he steels his resolve with these gritty words: “The pain's just a program.”

Granted this character is a Host, rather than a human. In Westworld, Hosts are extremely lifelike robots or cyborgs, who actually can think and feel. However, everything about them, including their mind, is manmade. Their flesh and blood only look, taste and smell exactly like “real” flesh and blood. Ultimately, every thought and sensation they experience is computer-generated. Even though they can feel it. The pain is just a program.

I’m thinking about this as I wake up and deal with my own pain. My gastrointestinal discomfort, which I live with every day, which goes hand in hand with my IBS and SIBO. This pain is just a program of my condition. How I respond to it, on the other hand—the story I tell myself about it, the program I assign to it—is up to me.

Pain is a hallmark of irritable bowel syndrome (aka IBS, aka the mother of SIBO). Irritable bowel syndrome is, of course, the most common gastrointestinal disorder in the developed world, “affecting 5%–27% of Western society. GI symptoms, including abdominal pain, bloating, distension, excessive wind, and altered bowel habit, characterize this condition when anatomical abnormalities and inflammation have been excluded.” [Extending Our Knowledge of Fermentable, Short-Chain Carbohydrates for Managing Gastrointestinal Symptoms. Jacqueline S. Barrett, PhD, BSc (Biomed)(Hons), MND Nutrition in Clinical Practice Volume 28 Number 3 June 2013 300–306.]

Abdominal pain. Bloating and distension. Excessive wind. Sound familiar?

In addition to pain itself, many people with IBS are known to suffer from something called chronic visceral hypersensitivity (also referred to as bowel hypersensitivity). Viscera in this case means our intestines, and hypersensitivity means we feel more sensation there, in our visceral, abdominal gut region, than normal people without IBS might tend to feel. A tiny bit of pressure feels like a great deal of pressure. A great deal of pressure feels unbearable.

I know this symptom well. It’s rare that I DON’T feel some pressure in my viscera, even after a good night of sleep and 12 or more hours of overnight fasting. To my disappointment, most days I wake up feeling not-empty. When I check my profile in the mirror, indeed my stomach is usually bloated. But often, it is not as bloated as it feels. And even if it were: Feeling bloated is just a program.

Bloating is not my first choice for a program. I’d rather have a different program. But I don’t. This is it, baby. It’s a FEELING. Feelings come and go. Some stay for longer, some for shorter. Long or short, it’s important to remember this:

I have feelings, but I am not my feelings.

And also:

This, too, shall pass.

One problem with visceral hypersensitivity is that it impairs your ability to ascertain whether the stomach is empty or full. This makes it tough to practice something like intuitive eating, a wonderful, non-dieting approach to food intake. Intuitive eating encourages tuning into and respecting the body’s natural hunger and satiety signals. But how can we respect our body’s signals when they are indistinct, if not indiscernible, due to a functional flaw in our hunger/fullness-perceiving mechanism. Can you say Catch-22?!

This problem is compounded by the fact that when a person with IBS feels bloated or in pain (which is, essentially, most of the time), the pain goes away while they are eating. Eating when in pain is never a good idea, everyone knows that. But ironically, the act of chewing and swallowing food causes the brain to release sedating serotonin and pain-killing endorphins. Therefore, eating makes a sore gut feel better, but only during the act of eating. Afterwards, it often feels way worse.

This final irony is really a challenge for anyone like me who’s ever suffered from a binge-type eating disorder and now has IBS. Your whole, viscerally hypersensitive, digestively disordered life can start to feel like one gigantic, non-stop trigger. Every. Single. Day.

So, let’s talk about IBS and eating disorders.

For a long time, researchers have recognized a strong association and even a causal relationship between IBS and disordered eating, particularly disorders of the binge eating (BE) type. Both bulimia nervosa (binge/purge cycling) and stand-alone binge eating disorder (formerly known as compulsive overeating, now simply BED) can lead to the development of irritable bowel symptomology.

In other words, eating massive quantities of food—not just once in a while, as on Thanksgiving, but day after day, again and again—screws up your gut.

This is not a shocking conclusion. It makes sense that chronically overloading your stomach, with or without puking afterwards, would screw up your gut, but why exactly this happens is not known for sure. An excellent research paper entitled “Binge eating, body mass index, and gastrointestinal symptoms,” posits three possible mechanisms for the observed association between bingeing and IBS. Because this is so important and so well-referenced, I’m going to quote the article verbatim, then summarize the passages underneath. Feel free to scroll down if technical jargon makes your brain hurt, otherwise, enjoy:

“The significant, positive association between BE and IBS symptoms, which persisted even after introducing potential medical and psychiatric morbidities (e.g., hypertension, Crohn’s disease, depression) and BMI, suggests that the influence of BE is particularly robust. Given the exploratory nature of the current analyses we present three potential interpretations of the underlying association between BE and IBS. First, both BE and IBS have demonstrated important relationships with psychosocial stress [29–31]. Stress is known to be a common precipitant of BE [29] and many individuals who struggle with this behavior may be prone to using BE in an effort to reduce anxiety or dysphoria [31]. In addition, stress is thought to play an important etiological role in functional GI disorders (the most common of which is IBS) [30, 32–35]. The observed association could potentially reflect a pattern that would be expected to occur if stress were a critical third variable that influenced both BE and IBS. While the current analyses do not lend themselves to mediation to assess the influence of stress, such analyses would be important to undertake in future studies.

“A second hypothesis is that the acute symptoms of IBS (e.g., nausea, diarrhea) may cause patients to either severely restrict their diets so as to avoid specific foods or to undergo prolonged periods of restriction to avoid IBS flares. Given the known association between dietary restriction and urges to binge [36], the observed association might suggest an inadvertent side effect of attempts to avoid IBS episodes via food restriction or limitation.

A third hypothesis is that individuals with concurrent BE and IBS may experience acute symptoms of IBS as a result of bingeing on foods that are not well tolerated. Symptoms of IBS are often triggered by food intolerance, particularly with foods that are high in fat content [37–39]. Macronutrient studies of those who engage in BE reveal that typical binge episodes are dense with high-fat foods and carbohydrates [40]. Thus, patients who struggle with BE may be more prone to IBS flare ups given that their binges are likely to be rich with foods that are poorly tolerated due to IBS.” [Peat CM, et al. Binge eating, body mass index, and gastrointestinal symptoms. J Psychosom Res. 2013 Nov;75(5):456-61.]

Okay, allow me to break those long paragraphs down to their essence:

Three Possible Reasons for the Association Between Binge Eating and IBS

1) Psychological Stress (causes both compensatory overeating, and cortisol-induced GI issues)

2) Restricted Diets that Eliminate IBS Foods/Triggers (dieting behaviors, rigid food plans, and restricting food intake in general causes compensatory bingeing)

3) Typical Binge Foods are IBS Triggers (the 2013 article mentions ‘foods high in fat and carbs’ as a primary culprit; if it were written today, I expect they would specify FODMAPs.)

Did someone mention Catch-22?

Now, just for fun, let’s throw visceral hypersensitivity into the mix. Feeling bloated all the time not only causes and increases stress levels, it makes it almost impossible to know, based on natural signals from your gut, if you are hungry, how full you are becoming during a meal, and when to stop eating. However, if you try to follow a portion-controlling food plan, you’re restricting. If you try to follow a SIBO-friendly or Low-FODMAP Diet, you’re restricting. And restricting leads to bingeing, and bingeing leads to IBS, and will you ever get off this merry-go-round, and if that isn’t stressful, I don’t know what is!

Talk about crazy making.

Okay. Deep breath.

It’s no surprise that stress is number one on the above list. Stress is at the root of IBS, no question. Therefore, finding ways to reduce and manage stress is of PRIME IMPORTANCE for people with IBS and SIBO. I can’t stress this enough, and it’s a big piece of what I work on with clients.

As for items 2 and 3, here’s where things get even trickier. It’s a fact that fermentable sugars and carbohydrates feed SIBO bugs, and that most fats and proteins don’t. Following a SIBO-smart diet is the most direct way to reduce the famous SIBO symptoms of gas and bloating. But if we force the diet or we restrict to tightly for too long, we risk going off the rails in a big way and really setting ourselves back.

This is the dance, finding the sweet spot between SIBO-smart eating and ease. Learning how to make intelligent boundaries around our food, eating inside those boundaries, allowing ourselves to eat outside those boundaries, and noticing the consequences of both. Living with it, and circling around, consciously.

As a clinical nutritionist specializing in SIBO, people expect me to practice what I preach, so I want to be clear: I don’t just preach “Eat this, don’t eat that.” I also preach tolerance. I also preach self-love. And what is very important for me, and for all of you to understand, is that everyone is ALLOWED TO GO OUTSIDE THE BOUNDARIES. Eating outside the SIBO-safe box doesn’t make you bad, wrong or undeserving in any way. It may make your tummy sore, it may make you gain weight, it may make you bloated, or constipated, or give you the runs. But at the end of the day, it’s just food. Food, and your body. How your body responds to food. And whatever you are feeling today, this too shall pass.

The important question is: How do you want to feel? How do you want to feel today? And not only today, but tomorrow? Because what you eat today is going to affect tomorrow. In fact, it may affect the entire next two weeks if you really go outside the boundary of what your gut handles best. We’ve all been there, and it’s not fun.

It’s not fun, but it’s okay. The pain is just a program. The program is in your mind.

Which brings me to a fresh idea: How about moving beyond the program? How about creating more ease around all this pressure to “be good” and “stay on plan” by dropping out of the program, out of your mind, and into the moment. Ask your body what it wants and needs right now? Slow down and check in. Cultivate an attitude of loving presence by practicing mindfulness and compassionate self-love.

The longer I am on this path, the longer I cycle through struggle and resistance and surrender and letting go, the more I am convinced that BEING SWEETLY PRESENT WITH MYSELF is the answer.

Being sweetly present with myself means non-judgmental checking in. Pausing and connecting. Looking at everything I know as tools, not rules. Asking my body how it’s feeling in this moment. Engaging playfully in an ongoing conversation with my body.

“Hello, my body! How are we feeling right now? What would you like to do today?”

My body is not the enemy. My body is my friend. It responds to whatever I provide as input—movement, stillness, food, no food, water, no water—it just responds. And by responding, it speaks. My body always does the best it can, and it is very forgiving, very resilient. Most importantly, it’s always there. Talk about a loyal companion!

Here’s a sweet exercise you can try right now.  Wrap your arms around yourself. Give your own shoulders a little squeeze or a rub. Now, rock yourself gently side to side, and say, “I love you, my body. Thank you for being there for me. Thank you for always supporting me. Let’s keep talking!” After you’re done hugging yourself, try putting one hand on your belly, and one hand on your heart, and saying kind words to yourself again. “Thank you, my body, for always being there for me. I appreciate you, and I love you.”

Make friends with your body. Continue the conversation. Be curious. Keep listening. Enjoy a full, deep breath together. Ask it what it wants. Maybe it wants to eat something delicious. Maybe it wants to go outside and play. Maybe it wants to rest. Whatever it is, and wherever you are, however you are feeling, just try to be with it. Be here.

And be kind to yourself, even when you hurt. The pain is just a program. Ditto for cravings, and compulsions. You can manage them, with knowledge and with kindness, returning to yourself again and again as you journey along your own, unique path of healing.