The Gut-Brain Connection: The Latest Research & Practical Approaches to Treatment

A webinar summary moderated by Yevgenia Pashinsky, MD, paneled by Sameer Berry, MD and Mariah Corneille, Psy.D.

Interventions, such as mindfulness, diaphragmatic breathing, and hypnotherapy, offer a promising approach to managing symptoms related to the gut-brain connection. By targeting the psychological and behavioral aspects of this connection, patients can improve their overall digestive health, reduce symptoms, and enhance their quality of life. These techniques work by calming the nervous system, activating the parasympathetic response, and improving communication between the gut and brain. With the help of board-certified gastroenterologists, dietitians, psychologists, and physical therapists, patients can receive comprehensive care that takes into account all aspects of their health.

What is the Gut-Brain Connection?

The gut-brain connection has been a hot topic in health and wellness recently, but what does it really mean? Dr. Sameer Berry explains that the gut-brain connection is the term used to describe the relationship between the brain and the gastrointestinal (GI) tract. Evidence shows that the brain and the GI tract are constantly communicating with each other, but what implications does this have for patients with GI conditions?

Implications for GI Patients

For patients with GI symptoms or conditions, understanding the gut-brain connection can be incredibly helpful for treatment. Dr. Berry emphasizes the importance of managing patients as a whole person, taking into account both physical and psychological factors. Dr. Mariah Corneille, a licensed clinical psychologist, highlights the need for integrated care approaches that consider both physical and mental health. At New York Gastroenterology Associates, patients have access to a team of professionals including gastroenterologists, dietitians, psychologists, and physical therapists who work together to provide comprehensive care.

Through ongoing research, we are learning more about the pathophysiology of these conditions and what it means for treatment. By understanding the gut-brain connection, gastroenterologists and other medical professionals are better equipped to treat patients and improve their overall well-being.

The Gut-Brain Connection: What is it?

The gut-brain connection refers to the enteric nervous system, also known as the second brain. This system protected us from environmental threats and it is responsible for the butterflies in your stomach when you are nervous or have abdominal pain when stressed out. Research shows that our brain impacts our gut and the symptoms we feel, but our gut can also send signals back up to our brain and impact our mood, anxiety, and depression.

The Role of Vagus Nerve

The vagus nerve is the longest neural pathway in the body, connecting the gut and the brain. It uses neurotransmitters, which are small chemicals in our brain that make us feel certain ways. The same neurotransmitters that conduct signals in our brain to make us feel happy or stressed can also make us feel certain GI symptoms, such as diarrhea, constipation, bloating, abdominal pain, and reflux. Additionally, 90% of serotonin, which is the happiness neurotransmitter, is made in the gut. Studies suggest that patients with irritable bowel syndrome and Crohn’s disease have a reduced vagal tone, indicating that it is functioning abnormally in these conditions.

The Fight or Flight Response

The fight or flight response is a hormonal response that prepares our body to take on a threat or stressor. In the GI tract, this response can result in bloating, flatulence, abdominal pain, diarrhea, and/or constipation. However, if this response is not toned down in certain patients who respond in this way, it can contribute to worsening GI symptoms. Chronic stress, inflammation, and higher levels of inflammation can create abnormalities in this part of our nervous system, and research shows high linkages between childhood trauma and past trauma and how this nervous system reacts. It is critical to work with GI psychology colleagues for a better understanding of how these nerve cells impact GI symptoms, which eventually lead us to create new treatment paradigms for our patients.

Brain-Gut Interaction and Psychogastroenterology

When it comes to treating GI symptoms, we often think that dietary changes are the first line of approach. However, many patients find that only focusing on food may not be enough to alleviate their symptoms. This is where brain-gut interaction and psychogastroenterology can come into play. By focusing on the psychological and behavioral aspects of the gut-brain connection, we can help manage symptoms that may not have an organic origin.

What is Psychogastroenterology?

Traditional psychotherapy may not be enough to manage GI symptoms, as it often focuses solely on emotional functioning. GI psychologists, on the other hand, utilize brain-gut behavioral treatments (BGBTs) to target the interactions between the gut and brain. By recognizing the back and forth nature of the gut-brain connection, we can develop interventions that help reduce and alleviate GI symptoms, improve overall digestive health, and enhance quality of life.

Diaphragmatic Breathing: A Foundation of BGBTs

One of the foundational techniques utilized in BGBTs is diaphragmatic breathing. This simple yet powerful technique not only helps with relaxation but also helps manage GI symptoms. By engaging in deep belly breathing, we activate the parasympathetic nervous system, which can help reduce the body’s stress response and inflammation. Diaphragmatic breathing exercises are easy to learn and can be done anywhere, making them a great starting point for those looking to manage their GI symptoms through psychogastroenterology techniques.

What is Diaphragmatic Breathing?

Diaphragmatic breathing is a technique that focuses on deep belly breathing to activate the body’s natural relaxation response. With this technique, we stimulate the parasympathetic nervous system, which helps improve gut health while reducing stress. Unlike regular deep breathing, diaphragmatic breathing emphasizes the contraction and expansion of the diaphragm, which strengthens the digestive tract, making it more resilient. It helps create an internal action that reduces stress in the gut-brain interaction, which can help alleviate symptoms of gut disorders like IBS, bloating, abdominal pain, GERD, and reflux.

The Benefits of Diaphragmatic Breathing for GI Symptoms

Diaphragmatic breathing offers various benefits to the gut, including reducing bloating, abdominal pain, and urgency before bowel movements. Deep belly breathing also helps improve digestion and reduce symptoms associated with GERD and reflux. Implementing diaphragmatic breathing creates balance between the stress response and the relaxation response throughout the day, which is essential for those experiencing chronic gut disorders. By putting a brake on the body’s natural stress response, it strengthens the digestive tract, and supports healthy bowel movements.

Benefits of Mindfulness for Reducing Stress and GI Symptoms

Mindfulness is a powerful tool to reduce stress and its impact on our physical and emotional health. It takes practice to train our minds and bodies to reduce our vulnerability to stress and bring our attention to the physical sensations in our body. Through mindfulness, we can regulate the connection between our emotions and physical symptoms, particularly GI symptoms like pain or discomfort. While it may be challenging to focus on thoughts and sensations during mindfulness, with practice, it’ll become more accessible, and it’ll be easier to maintain focus.

Guided mindfulness, particularly gut-directed meditation, can be a helpful intervention for those dealing with GI symptoms. During mindfulness meditation, patients are encouraged to embrace the sensations in their gut, envision those physical sensations, and replace negative messages with calming or soothing ones. To get the maximum benefit of mindfulness meditation, working with a licensed professional is recommended. This ensures that it’ll be a guided, targeted, and comfortable experience that brings the body to a state of relaxation.

Benefits of Gut Focus Hypnotherapy for Reducing GI Symptoms

Gut focus hypnotherapy is another emerging intervention that can have long-lasting benefits, particularly for those suffering from irritable bowel syndrome. Unlike mindfulness, it’s more of a passive approach, where patients enter a deep state of relaxation to enhance the signals between the gut and the brain. This deep state of relaxation can help the brain focus on helpful stimuli and receive signals more effectively, leading to better control of symptoms.

During hypnotherapy, the clinician uses verbal repetition and mental images to describe a calming or peaceful scene that the patient can focus on. This helps to facilitate a sense of calm and peace within the individual, allowing them to open up to suggestions that’ll help them control their symptoms. Hypnosis isn’t about mind control; rather, it’s a tool that helps us feel more in control of our symptoms. Verbal suggestions like “comfortable warmth in your stomach” can help create comfort and control, which the clinician may repeat several times to reinforce the message.

Gut-Focused Hypnotherapy: Telling Your Body and Mind You’re Safe

Gut-focused hypnotherapy is a way to communicate to your gut to send signals to your brain that you are calm, at peace, and above all, safe. This technique is especially useful for those who perceive threats where there are none, giving reminders to the body and gut that you are out of danger. Evolutionary-wise, this makes a lot of sense since our body has developed this reaction over time. A session of this therapy can last about 10 to 15 minutes, where the goal is to promote calmness and a sense of safety to your gut.

Digital Therapeutics: An Easy Way to Practice Gut-Focused Hypnotherapy

Gut-focused hypnotherapy can also be delivered through the use of digital therapeutics. The entire process can take only 15-20 minutes of your day, and some apps don’t even require a prescription. This is ideal for those who have busy schedules, as you can easily slip it in during waking up, lunch breaks, or even before going to sleep. It’s impressive how digital therapeutics have made it convenient to implement gut-focused hypnotherapy interventions.

Neuromodulators: A More New Wave Approach to Treating Gut-Brain Disorders

Neuromodulators are medications that aim to improve disorders of gut-brain interaction. They work by rewiring communication between the gut and brain. Some antidepressants, such as tricyclic antidepressants (TCA) historically known as not the best for depression, have been shown effective in treating GI symptom pain as they improve chemical messengers that facilitate gut-brain interactions. People with IBS-induced insomnia can also benefit from TCA medication, which can improve their sleep quality. Neuromodulators produce long-term effects, usually lasting around five to seven years. Neuromodulators are a more recent approach, yet have shown great benefit in improving conditions affecting the gut-brain connection.

Impact of Gut Loss on Serotonin Levels

Losing a good portion of the gastrointestinal gut due to inflammatory bowel disease can have a significant impact on serotonin levels. Since there is so much serotonin in the gut, patients who’ve lost their colon or had multiple resections of their small intestine may be at risk for losing serotonin. However, there isn’t much data to support this claim, and the body usually compensates for lost neurons. But, any surgical intervention can disrupt neural connections and lead to visceral hypersensitivity, which causes hypersensitive nerves, leading to pain and discomfort.

The Connection between the Microbiome and Serotonin Levels

Apart from neural connections being disrupted, the microbiome is essential for producing neurotransmitters like serotonin. The microbiome produces precursors and helps in producing and metabolizing these neurotransmitters. However, the microbiome also undergoes changes depending on food intake and other factors, leading to changes in serotonin levels. Hence, treating both inflammation and visceral hypersensitivity is essential to manage symptoms. Biologics are not designed to target visceral sensitivity, but treating both conditions is necessary to control symptoms. Patients who undergone weight loss surgery may also experience visceral hypersensitivity, which needs to be addressed by treating depression and psychological difficulties surgically.

Microbiome Connection and Mind-Gut Therapies

Studies have explored the link between SIBO, the microbiome, and other gut-brain interactions. It remains unclear what role these factors play in GI care and whether a connection exists with mind-gut therapies. Given the complexity of these interactions, it is critical for patients to consult with a board-certified gastroenterologist who stays informed on the latest research to understand each nuanced case.

Recognizing Chemical Messengers and the Microbiome

Educating patients on the microbiome and the chemical messengers it sends to the brain is crucial for normalizing their experience and reducing stress. It is common for patients to assume that negative experiences or alterations to their microbiome mean they are damaged for good. However, this is not the case: these alterations can be rewired and healed through various therapies.

Research and the Use of Marijuana

While there is ongoing research on the impact of THC and CBD on a range of GI conditions, it is too early to conclude definitive results. One of the challenges in researching marijuana stems from the lack of regulation, making it challenging to assess the quality of THC or CBD from edible products, smokable products, or topical products. Therefore, pediatric gastroenterologist and families that are considering the use of THC or CBD should proceed with caution and consult with their physician beforehand.

Impact of exercise and diet on GI Health

There have been many questions about the impact of exercise and diet on GI health. Exercise and dietary changes may improve GI symptoms and overall health; however, there is no one size fits all approach. Working with a gastroenterologist and other health professionals, people can find the right combination of diet, exercise, and other therapies to support a healthier GI system.

The Importance of Brain-Gut Behavioral Interventions

Brain-gut behavioral interventions are crucial when it comes to treating gastrointestinal symptoms. Exercise is a core component of GI care, and it’s essential to counsel every patient to exercise, eat well and sleep well. This is because inflammation is likely to go up without proper sleep, nutrition and exercise. However, sometimes it’s challenging to sleep well when GI symptoms are not under control. This is where working with a team who can help with medication and nutrition comes in handy. Brain-gut behavioral interventions often bring GI symptom relief, although there’s a need for trauma focused therapy in some cases.

Trauma Therapy for GI Symptom Relief

Brain-gut behavioral interventions can rebalance and rewire the gut for curative results. Sometimes, trauma is linked to childhood hospitalizations or experiences related to eating or sleeping. Trauma can also manifest physiologically within the body as physical health complaints. Therefore, traditional psychotherapy is necessary if the trauma is unresolved alongside brain-gut behavioral therapies. Finding the right therapist who can be trusted is crucial when seeking trauma therapy. Additionally, probiotics should be taken carefully because they can reduce microbial diversity. Therefore, less is often more when it comes to the use of probiotics.