The Mental Health of South Asian Americans with IBD

May 19th was Inflammatory Bowel Disease (IBD) Awareness Day, so I thought it fitting to explore the implications of mental health in South Asian Americans (SAA) this Asian American Pacific Islander (AAPI) Heritage Month.

Symptoms of IBD

There are two types of IBD: Crohn’s Disease (CD) and Ulcerative Colitis (UC) and the following are common symptoms:

• Diarrhea
• Unexplained weight loss
• Bloody stool
• Fatigue
• Reduction in appetite
• Abdominal pain
• Fever

Futher complications of IBD

• Colon cancer
• Side effects from medications
• Inflammation in other areas of body
• Sclerosing Cholangitis
• Blood clots

Diet and Lifestyle Implications on Mental Health

In South Asian (SA) culture, people can seek a holistic treatment regimen such as Ayurveda or Homeopathic as an alternative treatment to illness utilizing allopathic therapeutics. The appeal of those treatment modalities is the sense of limited side-effects as opposed to allopathic treatment. Furthermore, Ayurveda and Homeopathic therapies are coupled with lifestyles involving spirituality, diet, and movement. Overall this may be a great way to treat illness when it encompasses several realms to treat the person as a whole, but it is a different challenge to treat IBD as opposed to general gastric distress.

Ayurveda and Homeopathic Treatments

There have been international research done on the use of natural remedies for IBD, however there are several critiques, such as the studies’ procedures or the number of clinical trials. Nevertheless, as with all treatments, ample research must continued to be done to determine effective therapies. In the resources section, there are a few studies that aim to add to the knowledge-base of eastern traditional medicine of IBD treatment. While these studies discussed the efficaciousness of Ayurveda and herbal supplements, some patients following similar regimens as indicated in those studies did not gain remission. The continued active IBD due to ineffective treatment, led to more severe illness. As one can imagine, chronic flares can lead to depression and hopelessness. Some individuals even further expressed frustration and resentment in finding that biologics has a higher efficacious rate in gaining remission, however is not a readily available treatment modality due to availability and financial reasons.

Diet

Although diet change has been found to be factor that assist in the symptom reduction (i.e. the anti-inflammatory diet, a low fiber diet, a gluten-free diet, or a low dairy diet to name a few), it alone cannot treat IBD. When diet is poorly used as a treatment strategy for controlling IBD, it can lead to poor nutrition and weight changes as a result of the of either of the illnesses’ symptoms, as well as lethargy due to the insufficient energy derived from the nutrients consumed. The results of these symptoms can lead to depression and anxiety due to poor performance, cognitive dysfunction, perceived “laziness”, for example.

The social implications on Mental Health

As previously mentioned, symptoms of IBD can be perceived as laziness, however in truth, patients may experience struggle with just getting out of bed due to the symptoms of IBD. In this section we will explore other social factors on IBD and mental health for SAA and SA alike.

Body Type

Having IBD can lead to drastic changes in body size as a result of nutrient absorption, appetite changes, lethargy, and the impact on growth in pediatric patients. Furthermore, the side-effects of cortical steroids, such as weight gain and bloating, and the body’s response to perceived starvation during remission (storing fat) can further exacerbate the changes in body size. Just as in any culture, the changes in body size as a result of IBD can lead to poor self-esteem and body dysmorphia, SAAs thoughts about their bodies are further compounded as a result unobtainable beauty standards and the lack of healthy representation in media. Furthermore, in patients with body size changes as well as with colostomy bags can struggle with desirability and fertility (historical data suggests that a colectomy can effect pregnancy in women). Furthermore, patients with colostomy bags, especially in younger individuals, struggle with visibility of the bags and other’s perceptions of it. These experiences can also lead to depression due to feelings of loneliness or social anxiety, out of fear of the judgement.

Religion

One of the major religions in South Asia, specifically India, is Hinduism. Hinduism is intertwined in the way of life for Indians as well as Indian Americans. Hindus believe in the concept of reincarnation and the role of Karma as well as Dharma. To pray and mediate is to find inner peace. This can be a contradiction to some individuals with IBD, as having IBD can be perceived has having “unclean” Karma, or imply that the cause of IBD is behavioral in nature (not “praying hard enough”). With such powerful implications, a Hindu may not derive inner peace from prayer and meditation leading to further anxiety (“why is this not working?!”) or depression (“I must be a bad person because I have IBD.”)

Closing Remarks

The aforementioned experiences are by no means exhaustive. Individuals with IBD from various cultural backgrounds can indeed affect mental health. IBD as well as IBS (Irritable Bowel Syndrome) are also affected by mental health. Therefore, treatment must involve physical health intervention as well as mental health intervention.

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Resources

Own Your Crohn’s – an award winning blog by Tina Aswani

IBDesis Instagram– community of South Asians with IBD

Mayo Clinic’s Definition of IBD

Inflammatory bowel disease in the South Asian pediatric population of British Columbia – Vared Pinsk, Daniel A Lemberg, Karan Grewal, Collin C Barker, Richard A Schreiber, Kevan Jacobson

South Asian Patients With Inflammatory Bowel Disease in the United States Demonstrate More Fistulizing and Perianal Crohn Phenotype – Sushrut Jangi, MD,  Alex Ruan, Joshua Korzenik, MD,  Punyanganie de Silva, MD, MPH

Comparison of Disease Phenotypes and Clinical Characteristics Among South Asian and White Patients with Inflammatory Bowel Disease at a Tertiary Referral Center – Vimal Bodiwala, MD,  Timothy Marshall, PhD,  Kiron M Das, MD, PhD,  Steven R Brant, MD, Darren N Seril, MD, PhD

Effects of Ayurvedic treatment on forty-three patients of ulcerative colitis – Manish V. Patel, Kalapi B. Patel, and  S. N. Gupta

Herbal Medicine in the Treatment of Ulcerative Colitis – Fei Ke, Praveen Kumar Yadav, and  Liu Zhan Ju

Translational Studies on Inflammation: Review and Implications of Traditional Indian Medicine for Inflammatory Bowel Disease – Uma Ranjan Lal and Inder Pal Singh

An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report – Barbara C Olendzki, Taryn D Silverstein, Gioia M Persuitte, Yunsheng Ma, Katherine R Baldwin, and David Cave

Nutrition Tips for Inflammatory Bowel Disease – University of California San Fransisco

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This month’s article was written by Aarti Felder, MA, LCPC. Aarti Felder is a daughter of Indian immigrants and is our Chronic Illness Specialist.