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Q&A with Dr. Athos Bousvaros 

Associate Director of the Inflammatory Bowel Disease Program, Boston Children’s Hospital

 

Athos Bousvaros MD, MPH is a pediatric gastroenterologist who has worked at Boston Children’s Hospital for over 25 years. As Associate Director of the Inflammatory Bowel Disease program at Boston Children's Hospital, he spends much of his time treating complex cases of Crohn’s disease and ulcerative colitis referred from across the country.  His research interests include identifying the cause of IBD by studying the intestinal microbiome, developing new therapies for IBD, and examining the immune response of IBD patients to immunizations.  He has over 100 original and review publications in medical literature. We had the honor of speaking with Dr. Bousvaros, and are so grateful for his sharing his time and insights with the Kids for Kids GI Project community.   

 

Kids for Kids GI Project:

As Associate Director of the Inflammatory Bowel Disease Program at Boston Children’s Hospital, your research interest includes developing new therapies for IBD. Are there any potential new therapies or treatments being investigated for which you are particularly excited about?

 

Dr. Bousvaros:

Honestly, nothing that I see as a "game changer," but I am excited about some of the oral treatments that are being developed for IBD, including the JAK kinase inhibitors (tofacitinib, upadacitinib) and the S1P receptor modulators (ozanimod).

 

Kids for Kids GI Project:

You have greatly contributed to patient education materials including co-authoring the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) book “Your Child with Inflammatory Bowel Disease,” helping develop medical comics including “Pete Learns All About Crohn’s and Colitis,” and “Amy Goes Gluten Free,” and collaborating on the NASPGHAN website GI Kids. When a family first receives a diagnosis, it seems these would all be excellent resources. Which would you recommend checking out first? Are there any other resources through Boston Children’s Hospital or any other sources that you’d recommend?

 

Dr. Bousvaros:

For IBD, check out the Crohn's and colitis Foundation and NASPGHAN websites, and if you want more information, the NASPGHAN book. For celiac, the Boston Children's website is great. 

 

Kids for Kids GI Project:

The following article from Harvard Health Publishing discusses how stomachaches are very common in children and “nothing serious at all,” but that sometimes a stomach pain can be a sign of a more serious problem. The article has a helpful list of warning signs to look out for. Here at Kids for Kids GI project, we would encourage families to review this list and in consultation with a family doctor, seek help of a gastrointestinal doctor if needed. Are there any other clues or symptoms that you think parents might look out for to determine if their child might have a more serious GI condition that should be investigated?

 

https://www.health.harvard.edu/blog/10-signs-that-a-childs-stomachache-could-be-something-serious-2017112112781#:~:text=Stomachaches%20are%20incredibly%20common%20in,of%20a%20more%20serious%20problem.

 

Dr. Bousvaros:

I think any child with chronic abdominal pain should be evaluated by a physician, and even a gastroenterologist, if the pain is affecting their quality of life.  Even if the pain is not caused by a disease like Crohn's or celiac, there are many things we can do to help treat typical belly pain (aka functional abdominal pain). 

 

Kids for Kids GI Project:

If there is one piece of encouraging news you can share with children who have a chronic gastrointestinal condition of any kind, what would it be?

 

Dr. Bousvaros:

There are many great health care professionals who care for children that are willing to help.  Also, more treatments are being developed daily!

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Discussion with Dr. Aviad Haramati 

Professor of Integrative Physiology in the Departments of Biochemistry, Molecular & Cellular Biology and Medicine (Nephrology), and co-director of the CAM Graduate Program at Georgetown University Medical Center.

“Do things in a mindful way instead of a mindless way.”

- Dr. Aviad Haramati

 

On behalf of the Kids for Kids GI Project, I had the incredible opportunity to speak with Aviad “Adi” Haramati, PhD on the topic of the mind body connection, which is a key component to having good gut health.

 

Dr. Haramati is Professor of Integrative Physiology in the Departments of Biochemistry, Molecular & Cellular Biology and Medicine (Nephrology), and co-director of the CAM Graduate Program at Georgetown University Medical Center. Dr. Haramati has been a visiting professor at over 100 medical schools worldwide.

 

Dr. Haramati seeks to improve medical education across the globe, especially with regard to the intersection of science and mind-body medicine.  Over the past 15 years he has advocated that mindful practices, together with group sessions, be integrated into the curriculum for training health professionals to improve learning and work environments at academic health centers.


Dr. Haramati shared some key points and helpful tips for the Kids for Kids GI Project community:

 

Mind-Body

The systems in our bodies are interconnected, and the influence of the mind impacts the functions of the body. The mind has the ability through various neural and endocrine (nerve and hormonal) connections to influence how that system functions.

 

Here are some interesting examples:

 

  • Heart rate can increase when a person feels stressed due to the body’s fight or flight response. By contrast, when a situation is resolved and the person gets a break, their blood pressure comes down as they relax.

 

  • Hands are colder when a person feels stressed, whereas a person’s hands will be warmer when they are calm and relaxed, as the blood vessels in their fingers will dilate. 

 

Mind and the Gastrointestinal (GI) System

The GI system is especially prone to neural influences and stress. Factors can irritate the GI system and at the same time, factors can help calm it too.

 

Dr. Haramati discussed several wonderful techniques to help calm the mind and body

Visualization exercise

  1. Begin to close your eyes and imagine a relaxing place (like a vacation or the spa).

  2. Imagine how you felt so relaxed at that place and think about it for about thirty seconds to one minute.

  3. While you’re doing that, do some deep breathing (breathing in through your nose, holding for three to four seconds, and then exhale through pursed lips- which extends exhalation by two to three times longer than normal).

  4. Repeat your breathing, again and again, which slows you down.

  5. Do this around five to six times.

This process slows down the sympathetic system (which constricts blood vessels) and raises the parasympathetic system (the relaxation mode).

 

Lemon exercise

  1. Close your eyes and visualize yourself picking up and then biting into a lemon, pay attention to see how it looks/feels/tastes/smells.

  2. By visualizing a lemon, the circuitry system released the response “I’m going to sense that, I’m going to start eating it.”

That process helps calm your system down. The suggestion of a certain smell can also trigger a calming response.

 

Listening to spa music

  1. Play spa music for a few minutes to lower your stress.

Using your auditory sense, you can relax, you go to a warm place as your body temperature actually warms up. 

 

Self-Awareness, Mindful Eating and other Gastrointestinal Considerations

 

There is a lot you may not know about yourself, your GI tract, GI health and disease. It all begins with noticing. Each of us must understand our own bodies through practicing self-awareness. It all begins with noticing and recognizing signs for the GI system.

 

Learn what your cues are and triggers for eating and how you feel. Like all else, eat in a in a mindful way, instead of a mindless way.

 

Some stress can be a good thing. When dealing with a stressful situation, our bodies use our resources in a better way. However sometimes when we have excess stress, we might not make good eating choices, and may be depriving the gut of important nutrients. So be aware of managing stress for best eating practices.

 

Another example of self-awareness with food is to try to notice when you eat if you’re being social or if you are actually hungry. Recognizing when you are actually hungry and when you are actually full is really important in terms of regulating your GI system as well. Know what your cues are and know what your triggers are. There are times where you might want to eat and there is no need to (sometimes you’re just bored), and there are times when you need to eat but you don’t because you’re too stressed.

 

Tip: Looking to make good choices around dessert time? You might have a real desire for dark chocolate and when you see it, you take it. This could be an example of a trigger food for you. Instead, try to take a tiny square of dark chocolate instead of eating the whole thing. That way you can satisfy your urge by eating the chocolate in moderation, and then you can have some berries, nuts, and more. And now you have a nice, decadent, but balanced dessert because you are satisfying your desire a little, but you are now more mindfully eating instead of mindlessly eating- because you’re limiting your trigger and eating something else/healthy with it.

 

We are so thankful to Dr. Haramati and we challenge you to do things in a mindful way instead of a mindless way, and to also see how can you decompress?

 

Interested in more on this topic?

Check out this interesting article from Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-brain-gut-connection

Please check back here for more doctor interviews and exciting news and events.

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