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June 8, 2020

Food As Medicine

The Overlooked Key to Remission in Inflammatory Bowel Disease

Inflammatory Bowel Disease (IBD) is becoming more prevalent around the world. In 1990, the number of people with IBD was 3.7 million globally. By 2017, that number rose substantially to more than 6.8 million – almost double! There are many treatment options available, but today I want to focus on the one that is often overlooked.

What Is Inflammatory Bowel Disease (IBD)?

Inflammatory Bowel Disease is an umbrella term used for two separate conditions: ulcerative colitis and Crohn’s disease. Crohn’s disease impacts anywhere along the digestive tract, while ulcerative colitis is limited to inflammation in the colon. They have slightly different characteristics, but very similar contributing factors and treatment protocols.

Protocols for IBD may include specific therapeutic diets, nutritional supplementation, exercise and movement, medications and the mind-body connection. It’s the latter, the emotional component, that is one of the biggest barriers to healing and the mind-body connection is a factor that is most often ignored.

How Are the Mind And Gut Connected?

The digestive tract is sometimes referred to as “the second brain”. Consider some of phrases we hear people say frequently:

  • “There are butterflies in my stomach.”
  • “I have a gut feeling.”
  • “That made me sick to my stomach.”

We don’t pay much attention to the actual content of these well-worn phrases, but there is substantial science that shows the physical connection between the gut and the brain. It’s called the gut-brain axis, or the gut-brain connection.

In fact, the digestive tract has its own nervous system – it’s called the enteric nervous system (ENS) and it travels from the gut all the way up the brain. Your gut has millions of nerve endings and produces chemicals that help modulate a variety of involuntary bodily functions. For example, ninety percent of all serotonin is made in the gut. Serotonin is a neurotransmitter we normally associate with the brain. The ENS works in concert with the central nervous system and the relationship is bi-directional. This means that what happens in the gut can impact the brain, and vice versa. What the mind perceives has a direct influence on the functioning of the gut.

One of the main signallers between the gut and the brain is the vagus nerve, which sends messages to the brain and receives messages from the brain, and influences the immune system and inflammation. Twenty percent of vagus nerve fibers send instructions from the brain to the stomach, while the remaining 80% send instructions from the stomach to the brain. Like our muscles, the vagus nerve can get weak – and stimulating it through actions like gargling, singing loudly and deep breathing can help strengthen the vagus nerve which, in turn, can help improve the immune system and lessen inflammation.

It is important for people with IBD to try and engage in activities that promote the relaxation response. The relaxation response promotes healing and has an anti-inflammatory effect. Relaxation is a function of the “rest-digest-stop-and-think” (parasympathetic) nervous system. The “fight-flight-fright” (sympathetic) nervous system promotes the inflammatory response when activated chronically, which we don’t want.

How Does Stress and the Mind-Body Connection Impact IBD?

Doctors and researchers denied the stress-IBD connection for many years. A landmark study in 2005 showed that:

  • Chronic stress, adverse life events, and depression can cause a relapse in patients with IBD
  • Adrenal function, gut flora, mast cell activation, and the hypothalamus mediate the effect of stress on inflammation in IBD
  • The symptoms of IBD may be exacerbated by the effects of stress on gut motility and fluid secretion

Since then, further research has proven and cemented the mind-body influence in inflammatory bowel diseases. Stress can cause flare-ups in both children and adults, activating inflammatory and immune responses. Stress weakens the intestinal barrier, which in turn disrupts the gut microbiome, the community of bacteria in the digestive tract. This further exacerbates inflammation and triggers an immune response.

How Stress-Reduction Treatments Can Help IBD Patients

There is a growing body of research about how psychological, emotional and relaxation-based treatments can greatly help patients with inflammatory bowel diseases. Some of the evidence includes:

  • Cognitive behavioural therapy can help IBD patients lower anxiety, improve mood and improve their quality of life.
  • Gut focused hypnotherapy can improve quality of life, reduce symptoms and can help regulate the immune system. In this study of colitis patients, hypnotherapy even prolonged remission – with 60% of those who received hypnotherapy maintaining remission for a year, compared to 40% in the control group.
  • In this study of IBD and IBS patients, 29 participants enrolled in a 9-week relaxation-based mind-body program that included breath awareness, meditation, yoga and guided imagery. At the end of the program, patients not only reported less anxiety and an improvement in symptoms, but researchers also discovered biological changes in the genes that influence inflammation.
  • In this study of 29 IBD patients, participants followed a 26-week program that included breathing, movement and meditation. By the end of the study period, participants self-reported fewer symptoms, improved mood and quality of life, and blood tests showed lower levels of c-reative protein (CRP), a significant marker of inflammation.
  • 77 patients with ulcerative colitis who enrolled in a 12-week yoga program experienced a greater improvement in quality of life and mental health, along with a reduction in symptoms, when compared to a second group. These benefits lasted for an additional three months after they stopped the yoga classes.

What You Can Do

As evidenced above, it is important to focus on stress-relieving activities to promote the relaxation response and consequently promote healing. Activities that stimulate the parasympathetic nervous system and the vague nerve are beneficial, particularly those that involve breathwork.

Everyone has specific stress-relieving activities that they enjoy. Here are a few suggestions to get you started:

  • Meditation
  • Light exercise
  • Yoga
  • Acupuncture
  • Massage
  • Nature walks
  • Music
  • Taking a bath
  • Colouring

Many of these stress-relievers are free or low-cost, and you can learn them easily from an instructor or from online tutorials. They are also simple to incorporate into your routine once you make them a regular habit.

An inflammatory bowel disease diagnosis doesn’t mean you are helpless. Dietary therapies are vital but they’re not the only component of the picture. You can manage symptoms and more importantly, improve your mental outlook by including mindful, relaxation-inducing treatments as part of your protocol.