Enhancing Patient's Well-Being
Amid mounting evidence of the powerful connection between the mind and the gastrointestinal tract — much of it pioneered by researchers in UCLA’s Vatche & Tamar Manoukian Division of Digestive Diseases — the division has established the Integrative Digestive Health and Wellness Program, where a team of experts works collaboratively to enhance each patient’s overall health and well-being.
Based within the Melvin and Bren Simon Digestive Diseases Center at UCLA, the program includes not only the gastroenterologists who manage each patient’s care, but also a GI nurse practitioner and mindfulness teacher with expertise in the brain-gut axis and mind-body approaches, registered dietitians with expertise in digestive health, and a GI health psychologist who specializes in the use of evidence-based psychological treatments to reduce symptoms and improve coping and psychological adjustment.
“In medicine there is a growing recognition of the value of taking a holistic approach to enhancing health — an approach that is tailored to individual patients’ needs and goals, and that recognizes the importance of nutrition, stress, and other lifestyle factors in their overall health and well-being,” says Lin Chang, MD, vice chief of the division. “By working together in an integrative fashion to meet each patient’s needs, we strive to achieve the best possible outcomes not only for each patient’s digestive health, but also for their overall well-being.”
The holistic, patient-centered approach is particularly important for people with chronic gastrointestinal illnesses or symptoms, Dr. Chang says, given the well-established connection between the brain and the gut as well as the critical role of diet in digestive health. She notes that the brain and the enteric nervous system — sometimes referred to as the “second brain” in the gut — communicate back and forth in ways that influence both mental and physical health.
“This is why when we are stressed we often feel it in the gut, and why people with anxiety or depression often have abnormal gastrointestinal function,” Dr. Chang says. “It is also why conditions once classified as functional gastrointestinal disorders, including irritable bowel syndrome, chronic constipation and chronic abdominal pain, are now understood to be rooted in altered brain-gut interactions.”
The Integrative Digestive Health and Wellness Program has embraced evidence-based dietary, behavioral, and integrative health strategies and offers them as part of a comprehensive approach to the care of patients with gastrointestinal disorders. Suzanne Smith, MSN, NP, a nurse practitioner with extensive experience in clinical care and research in gastrointestinal disorders and brain-gut interactions, also has special training in mind-body approaches and is a certified mindfulness teacher. As an integrative health practitioner, Smith’s goal is to empower patients to actively engage in their health through practical health-promoting behaviors and mindfulness-based interventions that have been shown to reduce stress and decrease symptoms.
“The integrative health practitioner provides tools and strategies for symptom management as well as health enhancement — promoting sleep, fitness, stress management, resilience and self-care, all personalized into a care plan for the patient’s condition, goals and lifestyle,” explains Smith, who is also instrumental in ensuring that the entire integrative health team works together in a coordinated manner.
While proper nutrition is vital to everyone’s health, it is a critical factor for patients with a gastrointestinal condition, many of whom suffer discomfort, pain and other debilitating symptoms that are exacerbated by the foods they eat, which in turn can affect their psychological well-being. “The internet and news media put out a barrage of information about the pros and cons of various diets, foods and nutritional supplements, much of which is either conflicting or not based on solid science,” says Nancee Jaffe, MS, RDN, chief dietitian with the Integrative Digestive Health and Wellness Program. “As a result, by the time many patients come to us, they are confused, frustrated, or both.”
Because the program’s registered dietitians exclusively see patients with digestive problems, they are able to work in tandem with the other integrative team members to offer practical, evidence-based dietary strategies suited to each patient’s specific condition and lifestyle. Often, Jaffe notes, these strategies not only help to reduce symptoms, but also provide patients with a much-needed sense of control over their health.
Many patients with gastrointestinal conditions can also benefit from working with Christina T. Gentile, PsyD, MA, who as the program’s GI health psychologist is specially trained in applying evidence-based psychological treatments to influence the brain-gut connection and improve patients’ symptoms and well-being. “For some patients, GI symptoms are worsened by stress, while for others, the stress of managing the symptoms can contribute to emotional distress and a significant impairment in quality of life,” Dr. Gentile notes. “When patients are referred to me by their gastroenterologist, I work with them to develop a treatment plan based on their goals, and together with their physician, we implement that plan in a way that addresses their symptoms and promotes a meaningful and fulfilling life while managing their condition.”
Among the evidence-based psychological treatments Dr. Gentile employs are cognitive behavioral therapy (CBT), which examines the role of thoughts and behaviors in the expression of GI symptoms to develop new approaches for symptom management and stress resilience; acceptance and commitment therapy, a mindfulness-based behavioral therapy designed to assist the patient with living in ways consistent with personal values while developing psychological flexibility to support adjustment; and medical hypnosis, a form of relaxation training that uses imagery and positive suggestion to lower stress arousal and calm the digestive tract.
Dr. Chang notes that UCLA’s Integrative Digestive Health and Wellness Program is at the forefront of a new approach to managing patients with GI conditions — one that recognizes the importance of not simply treating the digestive tract, but also looking at the whole person and developing a comprehensive approach to enhancing health through a multidisciplinary team of experts. “Our integrative health team is dedicated to providing individualized, patient-centered care grounded in the latest knowledge about digestive health, the brain-gut connection and strategies for improving the health and quality of life of patients who are experiencing these conditions,” Dr. Chang says. “We help patients identify the approach that is best for them, then work as partners to help them achieve the best possible outcome."