There is the brain in your head and there is also the brain in your gut (aka the enteric nervous system). This “second brain” is made of over 500+ million neurons that are located in the lining of the digestive tract, from the esophagus to the anus. We’ll just call this the gut for short. The brain-gut connection plays a large role in chronic digestive disorders.
Understanding how the brain-gut connection works is an important piece of the puzzle. It can often lead to useful insights on how the default pattern can be working against you and making an already difficult condition even harder and more exhausting.
It’s a Two Way Street
What happens in the brain affects the gut
The evidence is clear that stress matters for chronic digestive disorders. In fact, not only does stress appear to make GI disorders worse over time, it is one of the strongest predictors of how severe the disorder will be over time. For organic digestive disorders (Ulcerative Colitis, Crohn’s Disease) anxiety and depression are associated with more aggressive presentations of disease and also linked to higher risk of surgery. This connection also holds true for functional gastrointestinal disorders as well (IBS, SIBO, GERD, dyspepsia, etc).
Even for people without any preexisting GI issues, if they struggle with depression or anxiety for long enough then they are likely to develop a digestive issue over time.
What happens in the gut affects the brain
The reverse is also true. If you have sustained imbalance in your gut, it’s bound to affect your mental health. The brain-gut connection is a two way street and people with chronic GI disorders that don’t start off with anxiety and depression already tend to develop a mental health condition over time. In fact, they are 6 times more likely than the average person according to some research.
“There is no doubt that stress is a triggering and exacerbating factor in relation to the course and symptoms of IBD.
Indeed it can be considered as one of the determinants of disease relapse.”
Psychological Issues in Inflammatory Bowel Disease: An Overview Gastroenterology Research and Practice, vol. 2012
A System For Different Times
The brain-gut connection is a very complex system that is only partially understood by medical science. One important factor of it though is that the brain and the gut signal each other based on short-term issues, like the need to fight or take flight away from a potential threat. Above all else, the nervous system prioritizes physical safety and makes these signals loud and clear.
It’s a system that evolved to help our ancestors survive getting eaten by predators. These days we no long longer need to worry about getting attacked by a mountain lion. Our threats are generally no longer external.
When you have a chronic digestive disorder the threats are on the inside rather than the outside. Symptoms like pain, nausea, fatigue, diarrhea can’t just be run away from. You take them wherever you go. In addition, having these symptoms again and again over time causes stress to build up. This stress then naturally causes a slew of reactions (anxiety, worry, irritability, depression, insomnia). These emotional reactions then get added on as the body registers even more threats.
This older system focused on safety from external threats like predators wasn’t made for responding effectively to these types of stressors. It only knows how to respond by hitting the “gas pedal” of the flight-or-fight response. When it comes to survival and running away from a mountain lion, digestion is a very low priority. The nervous system cares a lot more about not becoming lunch than properly digesting lunch. So when the gas pedal signal arrives in the gut it signals it to shut down and expel.
This produces more of what caused the stress signals in the first place – urgency, pain, diarrhea, constipation and so on.
The cycle continues as the brain gets the messages back from the gut and it becomes more vigilant and hypersensitive to pain and discomfort anywhere in the abdomen. This then causes more anxious thoughts that are predicting what’s going to happen next. It’s a vicious cycle.
Not Your Fault
This cycle is both common and backed by research. It’s also important to understand some further details.
1 | Stress is not the cause.
Stress, anxiety & worry interact and strengthen the vicious cycle but they are not the cause of your disorder.
2 | You’re not crazy & this isn’t your fault
Stress, catastrophic thinking, excessive worrying, hopelessness and emotionally shutting down are very common parts of having a chronic GI disorder. This is not your fault and you aren’t to blame if you also experience this.
Psychology to the Rescue
Nearly all of the focus of treatment of chronic digestive disorders is focused on the gut through supplements, diet, medications and surgery. The gut is only part of the equation though. The brain’s role in continuing this cycle is an important and often overlooked part. This is where the field of psychogastroenterology comes in. Yes, there’s a whole field of study for this.
Psychogastroenterology is the application of scientifically based psychological principles and techniques to help treat chronic digestive disorders.
The Role of Mindfulness
The people that don’t do well with chronic illness struggle with being “cognitively inflexible”. This means they fall into the trap of digging in their heels and persisting in continuing to react to life the same way as before, even though it’s not helping. They tend to pressure and judge themselves internally or get caught in irritability and anger from focusing on how unfair this all is.
Having chronic GI problems sucks. None of us would choose this for ourselves but it’s not going away, at least anytime soon. It’s a bold move to acknowledge this, have some humility and to begin to learn how to work with it.
The people that tend to do well are the ones that adapt to life with chronic illness by learning new skills, approaches and attitudes. One of the main research-backed tools in psychogastroenterology is mindfulness.
Mindfulness is not a quick fix or a relaxation strategy to distract you from stress or pain. It’s not aimed at having you think more positive thoughts Instead, it’s a fundamental and powerful tool for helping people to learn how to be flexible and to respond to their stressor rather than react. You can slow down and work with stress rather than turning away and avoiding it.
Mindfulness builds self-awareness. Without awareness we are destined to keep making the same decisions over and over.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962285/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371005/
https://gut.bmj.com/content/61/9/1284.short
https://onlinelibrary.wiley.com/doi/full/10.1111/apt.12195
https://www.sciencedirect.com/science/article/abs/pii/S0016508518300684