Crohn’s and Colitis Canada is helping a team of clinician-researchers in Manitoba propel innovative approaches to study mental health and nutrition issues linked to inflammatory bowel disease (IBD) – and design new ways to support Canadians dealing with these challenges.
Dr. Charles Bernstein, a gastroenterologist, is founder of Manitoba’s IBD Clinical and Research Centre, and Dr. Lesley Graff is professor of clinical health psychology at the University of Manitoba. They are leading important new efforts into studying how the brain changes in the presence of IBD as well as how to proactively care for individuals living with IBD and the unique forms of distress they may experience.
They are also the newest members of the
Crohn’s and Colitis Canada PACE Network, selected to join this pan-Canadian specialist group for their expert focus on mental health and nutrition.
“People with IBD and mental health concerns more often land in the hospital, and face worse outcomes than those with IBD alone,” says Dr. Graff. “The mental health element often goes untreated, even though it can change the course of their disease. Our goal is to reduce their stress while examining what makes IBD-related mental health issues unique – so we can offer them personalized therapies that work.”
The gut:brain connection
Past studies show that changes in the gut can affect our behaviour, our mood, and cause anxiety. That’s because our gut and brain communicate across many different pathways, creating deeper connections than with other organs.
With IBD, this communication is disturbed, and can trigger a chain reaction that leads to stress, anxiety and depression, while worsening IBD symptoms. About one in six people with IBD suffer depressive disorders, which ignite right alongside flare-ups.
Unfortunately, treatment for these mental health symptoms are limited and imprecise.
Dr. Bernstein has been looking at the brain’s function in the presence of pain and other chronic disease symptoms for decades and says, “We can’t treat depression as a one-size-fits-all because we don’t know if someone with IBD will, for instance, respond to medications the same as someone else”.
Imaging the brain to find new answers for depression amidst IBD
As few studies have sought answers to how the brain and gut may interact, Dr. Bernstein and Dr. Graff launched their own project, thanks to a three-year grant-in-aid of research grant from Crohn’s and Colitis Canada.
“With patients now recruited, we are set to search for regions of the brain that are structurally or functionally different in people with IBD and depression,” says Dr. Bernstein. “We hope to determine if there are specific approaches to treating mental health that generate better outcomes for these patients.”
The research team will use new MRI imaging techniques to not only see if there are differences in how the brain looks physically, but also in how it functions – for example, blood flow fluctuations. This may identify regions in the brain that aren’t working properly and thus reveal clues as to how mental stress differs in someone with IBD, and what treatments may work best.
This work has the potential to answer important questions, such as: how does IBD impact the brain-gut communications? Does the brain change in structure, or do certain pathways activate differently? How does this compare to people with IBD and those without? Is IBD depression more resistant to typical psychological approaches? Does IBD alone, without depression, change the brain?
Mental health and nutrition focus in the PACE Network
As the newest members of Crohn’s and Colitis Canada’s
PACE Network, Drs. Bernstein and Graff are applying their expertise in psychological support and dietary interventions for people with IBD.
“Through PACE, we will bring clinical psychology and nutrition in an organized way into the clinic,” Dr. Bernstein says. “When it comes to diet, we know little about what foods someone with IBD should eat, and what to avoid. Yet, this information is what most of our patients ask for.”
The doctors are introducing a new online screening tool that patients can use to describe their mental health, diet and nutrition needs before visiting their gastroenterologist. This virtual tool tells the specialist team how each patient is coping in real time while giving a window into their dietary habits. For this, researchers will begin by focusing on people facing a new IBD diagnosis, a period of often intense stress where they must confront their changing body while worrying about how the disease may affect their life.
The goal of this PACE project is to create a new model of care that reflects both the psychological and nutritional impacts of IBD, which can be consistently and easily implemented in clinics across the country.
A future of integrated care
Today, there is growing awareness amongst patients and healthcare providers about the unique links between mental health and chronic inflammatory diseases. As the stigma around mental health subsides, patients and families are advocating more, and healthcare providers have greater avenues to direct them to resources and support.
This new research affords even more hope: that people with IBD can eventually access treatments tailored to support their particular mental health needs. Dr. Bernstein says of IBD management: “I think it’s as important to focus on mental health as it is to manage your flare.”
The team hopes to help drive an integrated, holistic approach to IBD care – and other chronic diseases with a psychological burden – for Canadians living in any community.
“The best part,” says Dr. Bernstein, “is that we can actually do this.”