IBS and the Gut-Brain Connection

>> Hi. In this lecture, we're going to explore irritable bowel syndrome known as IBS for short. There's a lot of great information to cover so let's get started right away. To understand what IBS is, it's helpful to compare it to inflammatory bowel disease or IBD. What you need to remember is that IBD is a condition that a doctor can diagnose, while IBS is any gut issue that a doctor cannot diagnose. However, that doesn't make IBS any less real or difficult for the people who struggle with it. IBS is a collection of symptoms with an origin that cannot be identified. Doctors often diagnose IBS when everything else has been ruled out. Here's an example. Imagine you have a client, Susie, and she visits her doctor with stomach pain and constipation. The doctor finds no obstructions and her levels of inflammation and immune markers are good. More than likely, she's leaving with a diagnosis of irritable bowel syndrome. Did you know that 40% of people who visit the doctor report gastrointestinal problems? And these are just the people who share this information with their doctors. Sixty million Americans suffer from IBS. This is a troubling number. Think about it. How many clients, friends, or family members do you know who have some kind of GI problem they cannot trace back to another condition or root cause? This can be discouraging for doctors and their patients because without addressing the root cause, they can't do much more than try to mask the symptoms. So what does a diagnosis of IBS look like? Symptoms may include a change in stool composition, chronic constipation or diarrhea, abdominal cramping, especially after meals, excessive gas, severe stomach pain, nausea, and mucous in the stool. Beyond the gut, symptoms may include headaches, fatigue, insomnia, or muscle pain. It's normal for anyone to experience these kinds of symptoms on the odd occasion. But with IBS, the symptoms are chronic, occurring for at least three to six months. As you can imagine, recurring symptoms like these can feel debilitating. Usually a person with IBS will feel relief from their symptoms after having a bowel movement, but this is temporary. IBS can wreak havoc on people's lives. As I mentioned earlier, this commonly diagnosed popular term isn't actually a condition. Without any physical obstructions or chemical problems in the body, a condition cannot be attributed. But when a client like Susie is experiencing gut issues, doctors fall back on the catch-all diagnosis of IBS, a grouping of symptoms that can't be explained by any one cause. It was previously thought that IBS was a psychosomatic issue caused by real or perceived stress, something that's "all in the head." This theory was problematic as it implied that a person could control their symptoms or think their way out of it. Anyone who's ever suffered from IBS knows this isn't always the case. In Ayurveda, the traditional medicine of India, IBS is often attributed to low ojas, which is a diminished immune response caused by stress, lifestyle, and diet imbalances. Ayurveda breaks down IBS into two different types based on which dosha is creating the imbalance. Doshas are the three energies that make up a person's composition, Vata, Pitta, and Kapha. Everyone has a different balance of these three doshas. IBS is usually conceptualized as a Vata imbalance, where stress needs to be managed or a Pitta-Vata imbalance that focuses on dietary changes in addition to stress reduction. Regardless of the tradition, IBS is classified as a gut-brain axis problem. But the more we learn about the gut-brain axis, the more we're realizing that the gut-brain is a bidirectional communication pathway and that IBS is much more than psychological. IBS is actually caused by any combination of things that can disrupt the nervous system in the gut, the production of digestive enzymes, and the muscular reflex system. Root causes of IBS can be SIBO, food intolerances, leaky gut, parasites living in the gut, yeast overgrowth, zinc or magnesium deficiency, or heavy metal toxicity. But the common disruption of the nervous system and reflexes is why IBS is categorized as a gut-brain axis dysfunction. Let's explore this further. What is the gut-brain axis, and what does all of this mean? As I mentioned, the gut-brain axis refers to the bidirectional communication between the brain and the gut. We actually also have a nervous system in the gut called the enteric nervous system. The enteric nervous system is part of the autonomic nervous system, and it controls all muscle contractions and reflexes that happened during digestion. IBS is characterized specifically by a disturbance of some sort in the autonomic nervous system. What used to be considered motility dysfunction is now being looked at as a breakdown in communication between the gut and the brain. The result is hypersensitivity, meaning the body starts responding to stimuli that normally wouldn't be painful. Now let's get into the physiology. The gut is considered the second brain. In fact, there are 100 million neurons in the small intestine alone. A neuron is a nerve cell that communicates and transmits information throughout the body like a control panel, sending signals to other neurons. We now know that our control panel isn't located in one central place, there is a control panel in the gut too. Neurons communicate with other nerve cells via neurotransmitters. You can think of it like a game of telephone, where a message is passed down a line of people from one individual to the next, each person receiving that message through their ears before communicating it along themselves. The brain sends all kinds of essential signals or neurotransmitters that tell the body really important messages like instructing your heart to beat. And as we have said, the gut is the biggest sensory organ, so it has a lot to say. There are about 20 to 30 various neurotransmitters in the brain. The gut has the same variety. If you think of neurotransmitters as the language through which neurons communicate, then your gut has the ability to communicate with as many words as your brain. It appears to be equally complicated and equally smart. Overall, only 1,200 nerve fibers connect the brain to the gut. Such a small number is part of why we believe it has a mind of its own. When you think about the complexity of digestion, this makes sense. The gut must send signals to contract muscles for peristalsis and to let the next piece of food move down the pipe. Neurons in the gut control both the mechanical and chemical processes involved in digestion, meaning they control reflexes, and signal the release of enzymes and hormones. This process is critical and complex. Bayliss and Starling, two scientists in 19th century England were the first to speculate that the gut has a brain. They discovered the peristaltic reflex, which they called the law of the intestine. This is the reflex that contracts smooth muscle and pushes the food down the esophagus. This law of the intestine obviously holds true when the gut is connected to the brain. But when Bayliss and Starling cut the nerves that connected the gut to the brain, something fascinating happened. When food was dropped down the chute, the law of the intestine still prevailed. This undermined the notion that the brain in the head controlled all activity and that anything not connected to the brain would remain inert. What do you think about this? Is it possible that the brain isn't running the show? If we think about it, our gut is feeling the outside world sensing our way through. Maybe that's why our stomach can be the first to notice our surroundings, causing us to respond before we even know what's going on. There's a theory that "butterflies" in the stomach can let the brain know that we're nervous rather than the other way around. The brain is just interpreting the stimuli or response and attaching meaning. We've recently learned that 90% of serotonin is produced and stored in the gut. Serotonin is the happiness neurotransmitter. The gut has tons of serotonin receptors, which may be why many medications that are meant to affect serotonin also cause gastrointestinal complications and initial nausea. Serotonin is also in control of motility. This means that serotonin regulates response, it's a modulator. When serotonin uptake is inhibited, over time, the serotonin receptors in the gut mucosa become desensitized, which can result in constipation. The gut goes from overexcited to sluggish. An imbalance can also cause too much stimulation, which can result in diarrhea. We're not quite sure how serotonin in the gut affects the brain. But many neurological conditions are coupled with IBS symptoms and vice versa. Serotonin also plays a role in sleep, mood, appetite, and pain sensitivity, as well as transporting regulatory messages. Therefore, it can effectively alter the volume of a signal or the degree of a particular response. For example, when you catch an unpleasant bug, your body will flood with serotonin causing diarrhea or vomiting. When serotonin is low, hunger can be triggered. Who knew the so called happy molecule could do all of these things. Since 90% is in the gut, serotonin seems to be an enteric nervous system neurotransmitter. That means it's one of the main languages being spoken. The gut also produces four other main neurotransmitters that are found in both the brain and the gut. They are GABA, brain-derived neurotrophic factor or BDNF, norepinephrine, and dopamine. Bacteria create many of these neurotransmitters. This all adds up to the argument that there's a brain in the gut. Numerous studies have found correlations between conditions in the gut and degeneration in the brain. IBS symptoms often go hand in hand with anxiety or depression. In fact, 66% of people with IBS also fit the criteria for a mood disorder. Have you ever noticed the connection between your mental state and the state of your gut? What about your clients? How many of your clients with IBS or symptoms of GI problems are depressed or anxious? In the United States, 40 million people have anxiety and depression is considered the number one disability. And interestingly, antidepressants are one of the most common treatments prescribed for IBS. All of the neurotransmitters in the gut may explain why serotonin and norepinephrine uptake inhibitors have been found to be effective medications for this issue. Inflammation in the gut can spread throughout the entire body and impact the brain. It can affect neurodevelopment, the brain's development at birth, and neurodegeneration, the brain as we age. Many kids with autism have gastrointestinal issues. If we can better understand the second brain, we may find clues to how the two brains are connected. The good news is that all of these things can benefit from healing the gut. The gut is at the root of so many problems that by simply creating better health and digestion, chances are your clients will start to experience improvements elsewhere too. Now that doctors and researchers are starting to understand the communication between the gut and the brain, they're seeing that IBS is not just a consequence of mental status, and that stress doesn't originate in one place. IBS can be broken down into psychosocial and physiological components. Mental stress can certainly contribute to IBS, but stress can also originate in the gut. Going back to our example from earlier, this means that Susie's mind and her gut, or the second brain, are both involved in creating her symptoms. The communication overlaps. For example, consider that Susie had a high level of stress in her family as a child, and that stress compromised her immune system and altered her microbiome. Then, as a result of constant illness, she was given many antibiotics at a young age, further compromising the microbiome. Now as an adult, she seems to have a low threshold for stress and pain, and an altered response to stressful things that happen. Many foods she eats may cause cramping and digestive issues. Cumulatively, this has led to the development of what we call IBS. With IBS, the body is unable to shut off what should be an acute stress response, which creates distress in the GI tract. IBS may not be a clear diagnosis, but suffering from gastrointestinal issues on a regular basis is a real problem. As a Health Coach, the best way you can help your clients with IBS is to provide validation, support, and a space to be heard. Dispel the myth that IBS is a problem that's all in their head or that it's their fault they're getting sick and not getting better. It can also be helpful to share stories of other clients with IBS who have learned to manage their symptoms. Just remember to keep it totally anonymous, and to remind them of bio-individuality. A problem with IBS is that it's a unique experience that can be very different from one person to the next. Clients can visit their GI doctor for treatment to reduce symptoms, but getting to the root cause will take deep healing on a gut level so that the gut is producing the right enzymes, neurotransmitters, and stress responses. Explain to your clients that IBS has no single cause. So there's no single solution that can be applied, and therefore, no quick fix. Our best advice is to take the time to get to know your clients, encourage them to seek medical treatment, and then work in collaboration with their doctor to help your clients improve their overall health and digestion. We'll teach you how you can help clients manage their symptoms through diet and lifestyle in an upcoming lecture. Let's recap the main points we covered today. IBS is a cluster of symptoms, not a condition. This diagnosis is given when doctors have ruled everything else out. There are a variety of root causes for IBS, but the underlying connection is that they all involve dysfunction in the gut-brain axis. The gut is our second brain, and it houses a huge amount of neurotransmitters. We're discovering that our gut health and mental health are more connected than we ever thought. A Health Coach cannot claim to treat IBS, but they can support, educate, and validate their clients. Clients can work to improve their health and digestion, which in turn will help them to start to feel better. Do you have personal experience with IBS or maybe a friend or family member who does? What is living with IBS like? Have you noticed a correlation between IBS and other symptoms, such as mood? Share your experiences in the Facebook group. Remember, this is a safe space for everyone to be heard and support one another. Thank you for traveling down this winding road with me to explore IBS and the gut-brain axis. I hope it has helped you understand more about our largest sensory organ and how it communicates. Goodbye for now.