We all know the expression “butterflies in my stomach” and we all tend to agree on what that feeling signifies for us at a psychological level.  We use this expression to describe feeling nervous, anxious, or excited.  But did you know that the butterflies you feel in your “stomach” are actually representative of a complex and powerful relationship between your brain and your gut? Or how about the expression “follow your gut ”…I am hoping after reading this blog those expressions will hold more meaning and curiosity than you previously thought.

The symbiotic relationship between our gut health and how we feel is a hot topic of discussion and research right now (see Perlmutter, Hyman, Wahls to name a few references).  We are increasingly aware of the important relationship between the balance of “critters” in our gut and how we experience our brain, mood and emotions.  So, before we begin to discuss what we can do to optimize this important and functional relationship, let’s take a few minutes to explore the underlying processes associated with this relationship.

From a holistic vantage point (Chinese Medicine, Functional Medicine, Naturopathic Medicine, etc.) our gut is known as the “second brain” and there are structural/anatomical reasons for this reference.  The “second brain”, known scientifically as the enteric nervous system, consists of sheaths of neurons located in the walls of our gut.  We refer to these sheaths as the vagus nerve and it runs from our esophagus to our anus, roughly 9 meters long.  Did you know that
–The bacteria, fungi and viruses that make up your body’s microflora outnumber your body’s cell by 10 to 1.
–95% of the body’s serotonin supply is found in our bowels.
— The vagus nerve contains 100 million neurons, which is more neurons than the spinal cord or peripheral nervous system hold.
— There are over 100 Trillion bacterial cells contained within the gut.
— Our gut sends far more information to our brain than the other way around.

When the precarious balance of bacteria in our gut becomes disturbed we often experience symptoms associated with IBS and other GI related disorders.  These symptoms are likely to start out as complaints of bloating, gas, constipation or diarrhea, cramping etc.   These symptoms are often the prodromal indicators of “leaky gut syndrome” where our gut wall become permeable and particles of food start to escape from the digestive and GI tract.  When this occurs the domino effect of issues becomes inevitable and thus begins the cascading symptom patterns that plague 10’s of millions of Americans struggling with GI related disorders (2010 estimates were hovering around 60-70 million Americans).  However, did you also know that these gut-based imbalances contribute to the epidemic of anxiety, depression and other emotionally based issues?  Because of the interconnectedness of our brain and enteric nervous system, via the vagus nerve, once our gut bacteria is out of whack, we are somewhat doomed to a pattern of emotional discomfort, usually marked by increasing episodes of anxiety and depression.

You might be wondering how our gut bacteria can become so disrupted.  Here are a few of the many ways in which we accidentally (and sometimes unavoidably) contribute to this pattern of disturbance:

    –Excessive and unmanaged stress
–Too much use of antibiotics
–Prolonged use of steroids
–Intestinal infections
–High sugar; low fiber diet (in other words, typical American diet)
–Regular consumption of alcohol

As a psychologist, I am trained to explore my patient’s experience of anxiety (for example) as it relates to his/her thoughts, feeling and emotions and the central nervous system.   Historically speaking, I have used various techniques to help patients regain a better foothold on the regulation of their sympathetic nervous system through mindfulness, meditation, and other modes of psychological intervention.   But as I have continued to evolve as a clinician, I have come to realize there is an infinitely more complex and holistic approach to helping my patients gain the knowledge, skills and collaborative partnerships to manage and eradicate the root causes of anxiety.  In my opinion, that includes exploration of self-destructive and self-sabotaging thought patterns, exploring past trauma, integrating new and better “tools” to manage the relationship between central nervous system and anxiety, and understanding how our brain function and gut health are (literally) connected.  The latter requires helping my patients to connect how their GI complaints are likely contributing to their experience of anxiety, panic, and general emotional “dis-ease.”

The statistics on anxiety are staggering and trending north each passing year.  Consider these stats for a moment- According to the Anxiety and Depression Association of America (and NIMH) anxiety is the most common mental illness in America today.  An estimated 40 million adults (18 and older) or 18% of the population endorse symptoms of anxiety (not to mention 1 out of 8 children).  Treatment of anxiety is a 1/3 of the $148 billion dollars spent annually on mental illnesses in America.  In other words, we spend $42 billion a year on treatment of anxiety disorders in America.  Women are 60% more likely to develop an anxiety disorder than our male counterparts.   These numbers are terrifying to me as a clinician, a woman and a mother.

On my intake form, I ask patients to note their history of GI issues (as well as to provide me with a detailed description of their typical weekly food intake) and universally I see a medical dx of IBS or other GI related disorders when the chief psychiatric symptom is reported to be acute anxiety, panic disorder, or other stress related clinical concerns.  Educating my patient’s about the above noted relationship between the gut and our brain is a responsibility I consider paramount to providing the best standard of care.  Again, as I noted in my previous blog about depression and inflammation, I work closely with a skilled ND here in Honolulu as well as a Functional Medicine doctor to provide my patient’s with a supportive and collaborative partnership aimed at empowering him/her to regain a sense of balance, emotionally and physically.  The relationship between your brain and the vagus nerve is a critical and complex dialogue that has far reaching consequences including influencing how we experience our emotions.  So the next time you feel that familiar sensation of butterflies, you might want to stop and think about how complex that dialogue between your brain and your gut really is.

If you are reading this blog and you find yourself relating to this content, I encourage you to seek out professional help to better address the symptoms of leaky gut syndrome. I will include the links to Functional medicine and ND websites I included in my previous post on depression and inflammation.  Taking the right type of probiotic to help restore balance in the micro flora in your gut is one step, but often with more advanced GI issues and more acute anxiety based symptoms there is a need to first heal the permeability of the gut wall before adding in probiotics.  This requires the use of food and supplements that are aimed at repairing the lining of the vagus nerve, GI tract, and restoration of stomach enzymes.  Additionally, there is a growing body of research that is exploring strain specific probiotics to help mitigate acute symptoms of anxiety.  For example, in clinical trials involving the study of mice Bifidobacterium longum and Lactobacillus Rhamnosus have shown to help normalize anxiety-like behavior (reference available upon request).  Lactobacillus appears to work on the GABA receptors, an inhibitory neurotransmitter involved in the regulation of acute anxiety.  GABA is the receptor influenced when you take a benzodiazepine such as Xanax or Ativan.  There is a bourgeoning area of interest and research exploring use of probiotics to treat a wide variety of mental illnesses.  Pharmaceutical companies are attempting to create a new line of psychiatric medications referred to as Psychobiotics, but this field of research is still in its infancy.

So, that being said, there is a lot we can do (as is often the case) right from the comfort of our own home to start the process of realigning the gut flora balance.  And, as you can imagine, most of it involves cleaning up our diet, being mindful of the relationship between food and mood, and exploring our habits and patterns.

Below are a few action steps you can take in an effort to begin the process of healing your gut, mind and brain: 

  1. Eliminate sugars- The “fake” sugars.  We are not talking about eliminating whole fruits.  Rather, cutting out the baked goods, cookies, ice cream, and store bought sugary products that wreak havoc on the bacteria in our gut and lead to cyclical patterns of emotional and physical cravings.  Attempt to eliminate all of these types of sugars for 90 days.
  2. Eliminate all simple starches and drastically reduce intake of even complex starches.  The goal here is to try to reduce the amount of glucose and thus yeast that develops as a result of high starch diet.
  3. Add in fermented and living foods.  Please try to avoid store bought yogurts even though they are considered fermented.  These products are loaded with sugars and often end up exacerbating imbalance vs being helpful.
  4. Avoid trans fats.
  5. Attempt to have the vast majority of your diet be plant-based foods.  Generally speaking, eat as many veggies as you want in any form you want. Avoid excessive use of store bought dressings etc., which are loaded with sugar and preservatives.  If your GI tract is especially damaged, consider cooking all your veggies before consumption.
  6. Consume foods high in Omega-3 fatty acids (walnuts, salmon, flax, some types of squash, etc).
  7. Discuss with your practitioner if the use of a probiotic or prebiotic will benefit your unique situation.  A probiotic introduces specific strains of good bacteria, while a prebiotic introduces carbohydrates that serve as food the bacteria already present in your gut.
  8. Exercise. Again, more days than not.  Enough to sweat.  The goal is to find joy in it.  But if you hate it, that’s ok.  Do it anyway.
  9. Drink mostly water.  Try eliminating all other juices, soda, etc for 90 days.
  10. Work with a skilled psychologist or mental health professional to metabolize past trauma, identify faulty thought patterns, and implement mindfulness based skills to better manage your central nervous symptom response to stress.
  11. Women: Get a comprehensive hormone panel and work with your healthcare practitioner to understand the relationship between your gut health, hormone balance and emotional equilibrium.

For more Information about the practitioners discussed in this blog, please see links below:

If you are interested in finding out more about Naturopathic Doctors or locating a practitioner, check out:  www.naturopathic.org

If you are interested in learning more about Functional Medicine or locating a practitioner in your area, check out: www.functionalmedicine.org

If you live in the Honolulu area and you are interested in connecting with Dr. Kristen Coles, ND please contact her at 808-943-0330.

If you live in Honolulu and you would like to connect with Dr. Nicole Gesik, DO (Functional Medicine Practitioner) please contact her at 808-521-8170.

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