 Hey guys, welcome back to my YouTube channel. This is Daniel Rosal here bringing you a video from Irrandom couch in Jerusalem now I have explained in a couple of videos people who've actually subscribed to me are gonna be like I can't believe he's making this statement again But I'm gonna do it one more time. I have been working hard over the past month or so to decrease The sheer randomness of this YouTube channel from talking about every topic under the sun to an actual couple of themes The themes I'm going for and I say this for people who may want to subscribe in the future You're already part of the subscriber community. It's going to be about Jerusalem Israel and interesting stuff going on here I know it's not the most super unique Theme, but that is what we're going to be shooting for and I'm trying to put all these other Random videos about completely different topics into like different boxes or buckets or channels on YouTube But bear with me. It's a work in progress So I interrupt the regular programming about Jerusalem and kebabs and whatnot to talk about instead of Jerusalem today You're gonna hear about something called Abdomenophrenic disinertia APD now I thought this video was really important to make for a few reasons number one I've personally been struggling with this for three years and I finally got like a name for this Condition about three months ago from my gastroenterologist Previously it was like you have something called functional dyspepsia and I've done videos about that Couple of videos. I've interviewed a couple of really really world-leading experts for this YouTube channel for those interested Check out. I'll put a couple of links in the description and secondly because I'm kind of in a slightly Advantage position in the sense that one of those experts who came on the channel was a very bright young Greek-American Gastro by the name of John Damianos who tweets a lot and he treats amazing stuff and he tweeted a few days ago That he and colleagues Had got a paper published Abdomenophrenic disinertia disinertia and now APD a narrative review Not it perhaps bedtime reading rather than If you're looking for your next death thriller published in the official journal of the American College of gastroenterology. That's like really big deal. So this is like legit combining those two facts number one I'm a patient not a doctor But there's very very little information about Abdomenophrenic disinertia out there on the internet Which is why I specifically wanted to make a video about it to tell folks who really have just heard this word From their doctor the basic things I heard from my gastro's a neuro gastro and a super knowledgeable guy in the field And what I've learned or the the the little bit the nuggets I've gleaned from following John on Twitter, especially the stuff he's been tweeting recently now my impression I don't I'm not I may actually not have to like put that disclaimer there my impression I think this is probably something that most people would would agree upon that in the world in this fascinating world of gastroenterology which as a patient I've been a sort of I was gonna say thrust into but forced to learn a little bit About more than I probably would like to over the past year. There's been this growing Sort of understanding that when people deal with chronic bloating not all bloating is due to excessive Gas so the traditional understanding has been that well if you have people like me or anyone else for that matter who's like Bloated all the time like what is wrong with this person in simple language a common premise has been well They've obviously got like a bunch of gas in their stomach and these conditions like cybo small intestine or bacterial overgrowth have been really like Investigated and there's probably been a bit of perhaps pseudo science Entered the picture as well about them and in recent years through basically some research It's become increasingly clear that when folks are chronically bloated. It's not necessarily they've done I've seen interesting studies where they look at the volume of gas Between a healthy control and someone with one of these Bloating problems and there's very little in it So the answer is not air essentially and that's prompted a search for other answers and this one of the promising directions has been Abdomenophrenic disinertia or an explanation for it now something that I think is interesting and again why I wanted to make this video Specifically now is that this is really like new research being put out there this Article and a link to it in the description From the AGC was published if I'm not mistaken Only this year like just now literally in January of 2023. So this is very much sort of emerging Research and emerging understanding for those just a couple more things in the prelude and I'll timestamp this video So so people can skip through because I'm really just trying to do sort of a brain dump of sorts here Roughly where this fits this abdomenophrenic disinertia I'll explain sort of basically what that is just in a just in a small bit is within this class of Disorders called DGB eyes DGB eye stands for disorders of great of brain guts D B G I Interaction brain gut disorder is what traditionally has been called functional as in functional dyspepsia something about the link between the brain does the brain your brain appear and the way your Your gastrointestinal tract operates is gone basically wrong the analogy that that that I Use if I were asking if I trying to explain to my doctor what having this actually feels like on a daily basis I don't know if anyone on the who watches this video has ever experienced the transmission belts and maybe getting the exact term wrong in their car when that breaks and The car becomes really jerky and sort of and that's to me what it feels like It's like I can feel all this stuff going on in my stomach that I just wasn't Sensation that I didn't have before it feels like something that connection is like sort of broken trying to keep this video in some kind of Coherent order abdomenophrenic disinertia the clue is in the name abdomino refers to and Preface again was the not a doctor stuff. So this is not medical information. This is just my understanding But in the interest of putting information out there for people who are trying to understand what on earth This is abdominal abdominal muscles phrenic related to the diaphragm disinertia related to a faulty Spreadive intermediate of energy between these two Organs right the abdominal muscles and the diaphragm which is also a muscle sort of useful thing about having this term is to One obviously hopes of bring some closer to actually doing something about it John tweeted and I'll put a link to his Twitter. It's amazing this little graphic yesterday I will put it. I will do a high-tech Rendering I'll put it actually up on the screen as well as this super super low-tech methodology I'm using right now But it's it explains a normal condition like how stuff is supposed to be and what goes wrong when you have this So on the left he has what goes wrong and it says chest down Abdomen out. So basically what this condition is about is that the coordination? The the the the teamwork between these two muscles has broken and that's and that's why your stomach is like bulging after you eat Right, so in the pathological condition the abdomen is out and the chest is down doctors who under actually understand anatomy You can fill in the details for me. I think that means that the Diaphragm is relaxed when it's supposed to be contracting. I think And that's why also when you have this you get like kind of shortness of breath I think and in the Correct operation of the two muscles you have abdomen in and chest up, right? So you basically relax and you get that like what I found in my three years of dealing with this for me to rehash old Stuff I've talked about before started after having my gallbladder surgery I don't know if there is an established connection yet between like specific Surgeries got like abdominal surgeries and this thing But that's how it actually began for me for me water is like the worst thing But essentially everything I eat or drink tends to cause bloating much more than it did But it was a light bulb moment when I realized that because water is the very worst thing It's not related to nutrients. It's not related to a food group, right water is kind of a nerd. It's just water So that was I think when I when my doctor was asking me well you say you're bloated all the time Is it like liquids foods? What is it exactly and I was like it's actually everything But water is worse now. Why is water worse than foods for me? And I think I've heard this from other people with functional dyspapsia and gastroparesis I think that's an unsolved mystery, but it's it's it's there as a thing now What I'm going to do for the rest of this video is just give a skim Through this paper to pick out what I think are you know sort of interesting things and I'll put the full text in The description so tidbit one that I don't want to miss Regarding this emerging sort of clinical entity of Abdomenophrenic dyscineria APD The people to follow because it's always good to follow if you're looking for answers people who are doing really good research And this is two people firstly is John Damianos is incoming to the Mayo Clinic I believe and there's a Spanish doctor based out of Barcelona a guy called Fernando as Piroth and I really hope that too Fernando I'm doing the Spanish pronunciation justice there These guys have together been doing a lot of research and they're both works it's both worth keeping on top of their their work So there's a few very interesting tidbits in here and it really talks about how the How this all works this kind of gut-brained is regulated Interaction stuff. So there's an interesting. This is on page two of their paper. It says Furthermore ingestion of lettuce which is like lettuce right as in the lettuce you put in burgers Which is a low-gas releasing substrate for microbial fermentation led to abdominal distension produced by uncoordinated activity of the abdominal wall in patients who believed That eating lettuce would cause them gas and bloating Suggesting that distension distension is when your belly gets observably big is a behavioral response more recent More recently a study in healthy Volunteer has demonstrated that voluntary contraction of the diaphragm is associated with abdominal distension and symptoms of bloating and Abdominal discomfort. So I hope so far in the video I've covered to the best to the best degree that I can with all those cavities by not being a Doctor and just being someone with this trying to piece together the info from these disparate sources But including this very very useful paper. I hope I piece together basically what this is What doctors know about why it occurs again as a reminder in the name It's the faulty coordination between the diaphragm and the abdominal wall But let's leave all the detail and nuance to the experts because if you're in my situation You're a patient and really all you want to have Happen is for this to go away. So what are the possible treatment options? So I'm gonna jump for a little bit to treatment and just some treatments and just summarize what these guys Have sort of pointed the way to in this paper. The first of these is EMG biofeedback and at the risk of breaking the copyright of the American Journal of Gastroenterology. I'm just gonna actually read directly here from the paper patients in the study used EMG activity as a visual signal for biofeedback Using the real-time EMG signal They were able to decrease EMG activity for the diaphragm and Intercostal muscles and this response was associated with the ascension of the diagram Which as far as I know is what should be happening reduction in abdominal girth and improvement in the subjective sensation of abdominal Distention similarly in a subsequent placebo controlled trial Barba et al found that the biofeedback technique enable patients was various DGB eyes and Symptoms of postprandial bloating to reduce intercostal muscle activity and increased and Increased anterior almost activity thereby reducing the sensation of abdominal Distention and perceived girth these data. I love when people use data correctly in the plural. That's wonderful These data indicate that patients can be trained to control Abdomenophrenic postural tone release the diet release the diaphragmatic blockade and Correct abdominal distention hence biofeedback may be useful to correct APD and abdominal Distention, however, the e now here's the catch guys, however the EMG techniques used is complex and Expensive and there is currently Extremely limited access and no standardized protocols So that's the good and the bad the good being that it seemed in these clinical trials that with EMG directed biofeedback folks with APD were able to actually tangibly physically reduce their bloating and the negative part is that as of this current time This is not something you can rock up to your doctor and be like, oh amazing I've had this thing and I've heard about this new condition called APD or you like understand better So I'll take the biofeedback, please So it's not something right now that like is in widespread clinical use and there's also no standardized protocols So there's two separate issues there basically the second potential treatment course that this paper directs to is diaphragmatic breathing and again rather than sort of me rehash the science elucidated here with probably varying degrees of Accuracy, I'm just going to read straight from their paper Diaphragmatic breathing is effective for treating aerophagia belching and rumination syndrome This technique may also be effective for the management of bloating because it targets the maladaptive Somatic response patients are instructed to inhale slowly while protruding the abdomen avoiding chest rise and then exhale Diaphragmatic breathing is indicated for 30 minutes after meals placing one hand over the chest and the other Over the abdomen a major benefit is that it is easy to learn and can be performed at home So right now given that this EMG Directed biofeedback is not something that we can just like sort of get access to at least one can learn a diaphragmatic breathing I'm currently watching YouTube videos and I'm gonna actually start this 30-minute thing when I Want to get a bit more a bit of time There's always there should always be time for diaphragmatic breathing in one's life Many gastros physical therapists and psychologists are also familiar with this technique Making it much more easily accessible for patients But its value for the treatment of APD has not been established the final treatment methodology That this group of doctors mentioned in this interesting paper is they kind of say well the FODMAP diet diet might work CBT might work got directed hypnotherapy might work And then also neuro modulators now I'll put a link to my my interview with with Dr. John Damianos because I personally learned a lot from it and neuro modulators refers to basically psychiatric meds that are used in typically lower dosages for the treatment of functional dyspepsia and or using the more updated terminology the DGB eyes the disorders of gut-brain interaction and You know the classic ones that most people who've been dealing with this and again You're gonna have to excuse my language for a second crappy condition. Whatever. Whatever one is is less is less inflammatory and insulting Maybe it's a it's really really not an annoying thing to live with our amy-triptyline and nor triptyline the drugs that are called the Tricyclic antidepressants, but they say in this in this paper a certain central neuro modulators and when when these drugs are used for Controlling these DGB eye symptoms are not we they're not called by doctors Antidepressants they're called neuro modulators. That was what John taught me. Thank you, John Central neuro modulators such as atypical antidepressants and whoo, this is a hard word Gabba pen it Gabba pentanoids are useful for DGB eye symptoms a recent placebo controlled trial of 85 patients with IBS showed the treatment with pre-galbin 225 milligrams twice daily Significantly improved abdominal bloating. However, the role of neuro modulators invisible abdominal distension and APD remains to be established and for the footnote for those really looking to track down The everything that came out of this the literature of you. That's footnote at 32 CBT seems promising because the target's maladaptive behaviors and helps regulate psychological and psychological responses to emotional and physical Stimuli, okay now to wrap up the video. I'm going to just read conclusion of future directions. That's the very last It's not I would I recommend folks who have this and are trying to learn about this people may have disagree that reading Literature or material intended for doctors is a is a worthwhile or it's a smart thing to do as a patient personally I think if you do it with the understanding that you're not a doctor and some of this is going to go above your head But I still think personally there's a lot of value in it So I'm going to just read off directly again There are conclusions in future directions because this and this concludes of the paper APD Abdominal phrenic disinertia in full is characterized by the pathologic contraction and descent of the diaphragm and relaxation and protrusion of the abdominal wall a series of studies indicate that this would normal response contributes to distension in DGB eyes including IBS FD and functional bloating and distension There are currently no diagnostic criteria for APD Dynamic cross-sectional imaging can identify APD, but less expensive and easily accessible technologies such as ultrasound may be more useful in Identifying and even treating APD There are promising data to support the use of biofeedback to treat APD But there are currently no standardized treatment protocols and access to biofeedback is limited Adjunctive treatments targeting central Sensitization and visceral hypersensitivity may also be helpful with the growing appreciation of APD And I think they mean appreciation in the in the sense of it's becoming more understood not that anyone's really grateful for It certainly has this for the existence of this condition Was the growing appreciation of APD and its contribution to DGB eyes future efforts should increase the understanding of APD develop standardized diagnostic criteria criteria and proposed Proposed evidence-based treatments, which is of course the whole mantra of traditional allopathic medicine if you have APD one of the DGB eyes is emerging clinical entity. I hope this has been just of some value I will link to the Full paper as I mentioned a couple of times now two people I recommend following a besides Dr. Jono, I'm trying not to keep mentioning less. I sound like a bit of a stalker I'm not stalking you John, but your Twitter is terrific and anyone who has one of these conditions whether it's IBS or FD or this APD It's really useful because he tweets a lot of new stuff coming out in terms of research and the second group is a organization called the Rome Foundation Which sort of attempts to put together the jigsaw of research being done in these directions Advocacy for patients and all that kind of good stuff and they have a really really terrific website and a newsletter and lots of info Of course as someone's with this myself. I don't recommend spending one's entire life Thinking about this do what you can Anyone I think that one of the good things from this paper the encouraging things is abdominal breathing because you don't need a doctor's Prescription you can teach it to yourself now after watching this video I guess all we can do is really hope that Treatments really emerge for this. Thanks for watching again. This YouTube channel is not about gastroenterology or My health struggles or or APD or anything But if you do for other reasons because you're curious about the other stuff that I post Want to subscribe here to me on YouTube hit that subscribe button. Thank you guys very much for watching