IBS & the mind
the importance of the brain-body connection in treating IBS
Digestive issues are a very common reason for patients to step into the clinic. Many have “tried it all” to resolve their symptoms, including experimenting with restrictive diets and eliminating foods in order to find the root of their symptoms. Some have been through the gamut of tests - scopes and blood work - only to be diagnosed with irritable bowel syndrome (IBS). But what is IBS, and what is the solution to addressing the symptoms long-term? Part of the answer might surprise you… and the amount of evidence backing it might surprise you even more!
IBS is what we call a “functional” disorder - essentially meaning that there is no underlying or identifiable disease to explain your symptoms. This is different from inflammatory bowel diseases (IBD) such as Crohn’s and Colitis, where we can see damage and inflammation in the digestive tract.
It has been a challenge for researchers to determine one specific cause of IBS and it’s likely related to variety of overlapping factors, including:
Changes to the lining and protective barrier of the gut
The immune system
The nervous system
Hormones
Brain structures and functions
Our stress responses
Mood changes
Cognition and thought patterns
Changes in pain modulation
Genetics
The gut microbiome
Many of these overlap and likely all play a role in what we call the gut-brain axis. The brain and gut impact and are impacted by one another through a number of pathways. Our autonomic nervous system and hypothalamic pituitary adrenal (HPA) axis may influence how fast things move through our system, how strong our gut barrier is, our immune function and even our gut microbial composition. From the other side, our gut - including the foods we eat - also play a role. Food (and microbes) we ingest can impact our immune system and the microbes that signal back to the brain.
Our brain is ultimately responsible for generating our experience of abdominal pain, discomfort and anxiety. We know that IBS often overlaps with other conditions, many of which are exacerbated by stress and/or a heightened nervous system sensitivity. This includes (but is not limited to) endometriosis, fibromyalgia, chronic headaches, TMJ pain etc. Stressful life events in early life may play a major role in our vulnerability to develop IBS, and stressors in adulthood may play a crucial part in the first onset and perceived severity of symptoms.
IBS can be hard to treat because there are so many factors - none of which fully or solely capturing the mechanism behind symptoms. Approaching care with an approach that supports you as a whole person (as we do for so many health concerns) allows us to support you more fully - and have better longer term and sustainable management. IBS isn’t - and likely won’t ever be - a condition where a single magic pill resolves all symptoms.
When we consider how important our nervous system, our experiences of stress, and our emotions are in our physical experiences of pain and digestion, it begins to make sense why cognitive behavioural and mind-body strategies are some of the most-effective treatments. This has been shown time and time again in research. We can’t ignore the gut-brain connection and mindfulness in your treatment plan.
Cognitive Behaviour Therapy (CBT)
Cognitive behaviour therapy is a short term, skills-based therapy that is focused on bringing awareness to unhelpful patterns of thinking and behaviours, in order to alter these patterns or behaviours. This in turn helps improve mood and psychological symptoms. CBT works well to treat and manage the symptoms of IBS, especially in those with anxiety.
While CBT can only be administered by a trained practitioner, many free online resources exist - and some specifically for IBS! Some of these have been shown in research to be just as effective as one-on-one care. Take a look at the free app Zemedy to learn more.
Mindfulness Stress Based Reduction (MSBR)
Mindfulness Stress Based Reduction is a structured 8 week intensive workshop program that focuses on cultivating mindfulness. This mindfulness is intentional, non judgmental, and invites patients to notice their present moment experience (feelings, physical sensations, thoughts) with curiosity and compassion. Research on these MSBR programs have been shown to improve symptoms for up to 6 months post treatment. The aspect of MSBR that makes the biggest difference in the IBS patient, is the improvement in their mindful attention. This allows them to resist acting on “auto pilot” and helps them avoid engaging in any worries - either past or future - or using previously conditioned reactions.
A simple way to engage with this skill of mindful attention (or to practice it) is through meditation. Studies on meditation seem to show that as little as 20 minutes, three times a week provide benefit. Try any of the free or paid apps like insight timer, calm, headspace to start your practice.
Journalling
Journalling is another mental-emotional tool that has been shown to improve quality of life scores in patient with IBS. Writing about your current stresses, deepest fears around IBS symptoms, and how you feel about your symptoms can help decrease the symptoms you may experience over time.
You can try using the following prompts to get started:
I am the most frustrated by my IBS when…..
My digestion affects my life by….
My IBS creates anxiety when I imagine……
When I think about IBS the thoughts that come to mind are…..
My deepest fear related to my IBS is……
Looking for more support with your IBS? Book a complimentary meet and greet with one of our naturopathic doctors to learn more about how we can support your health concerns with a holistic approach.