IBS and the Gut-Brain Connection
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>> 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.