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IBS Treatment Package

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The Gut Brain Axis

By Jo Cunningham

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The relationship between our gut and our brain is an exciting area of current scientific research, and Irritable Bowel Syndrome (IBS) has been reclassified as a disorder in the gut-brain interaction.

How does the gut talk to the brain?

Familiar with ‘butterflies in the stomach’, or a ‘gut feeling’ about something?

The gut and the brain are physically connected through millions of nerves, and the constant communication between the brain and the gut is referred to as the gut-brain axis. 

The vagus nerve is the main component of the parasympathetic nervous system which regulates our “rest-and-digest” response, as well as acts to combat the sympathetic nervous system’s “fight-or-flight” response. This means that if we are stressed, the vagus nerve is inhibited, and stress signals are sent to the gut which can affect gut motility, which may lead to altered bowel habits and other associated symptoms. In contrast, when we are not stressed, the vagus nerve can send signals that increase our digestion, and slow our heart and breathing rates. 

Our understanding of the extent of the gut-brain relationship continues to deepen with recent trials suggesting that a diverse gut microbiome (the trillions of microbes in our gut) can have a positive effect on our mental health. The SMILES trial has shown that the group of people who increased their intake of plant-based foods such as fruit, vegetables, wholegrains, legumes, nuts, seeds and fish and healthy fats alongside reducing their intake of convenience or highly processed foods were 4 times more likely to resolve their depression than those who received counselling alone. 

Why is the gut-brain axis important to consider in IBS?

When considering digestive disorders such as IBS, or symptoms such as constipation, diarrhoea, abdominal pain and bloating, the gut-brain axis can have a huge part to play. When we feel stressed or anxious, the body redirects blood flow away from the gut which can lead to symptoms (mental stress can trigger physical stress along the intestine).

Several trials have compared the effectiveness of diet and non-diet therapies for the treatment of IBS. The non-diet approaches included cognitive behavioural therapy (CBT), relaxation techniques, gut-directed hypnotherapy and yoga. Several of these trials showed that the non-diet approaches improved gut symptoms just as much as the dietary intervention, which was the low FODMAP diet. These results are incredible, and show that without removing trigger foods the non-diet approaches target the underlying cause which is the dysfunction between the gut and the brain via the vagus nerve. 

It is worth noting that these non-diet approaches tend to take longer to take effect, so if someone is planning on taking this route they need to stick at it for at least 12 weeks. 

  • Gut-Directed CBT

Cognitive-behavioural therapy (CBT) has been well researched, and a recent systematic review found that CBT has consistently demonstrated that clients can see significant and long-lasting improvements on their IBS symptoms and quality of life using this psychological approach. 

CBT will be delivered by a suitably qualified therapist, and may be individual or group sessions that may be in-person, online or over the phone. CBT for IBS won’t be the same as general CBT – it will be a specially designed protocol that improves and regulates the gut-brain axis interactions. 

If someone is keen to explore CBT for the treatment of their IBS we often point them in the direction of Dr Sula Windgassen or Dr Alexa Duff.

  • Gut-Directed Hypnotherapy

Gut-directed hypnotherapy (GDH) has been shown in recent studies to reduce gastrointestinal symptoms (including abdominal pain, bloating, diarrhoea, and constipation) in Irritable Bowel Syndrome (IBS) patients by 70-80% as well as reduce feelings of anxiety or depression and improve quality of life. 

GDH can be delivered via a suitably qualified therapist (we often refer to Helen Brookes), and you can also now access it via a mobile app called Nerva which is based on research by Monash University . 

GDH differs from other psychological therapies like CBT which are aimed at the conscious mind. Instead, GDH guides you into a deeply relaxed state so that suggestions for symptom normalisation are delivered to the subconscious mind with powerful imagery. This could be for example imagining your gut as a free-flowing river with no obstacles or blockages. It’s important to note that at no point are you not in control like you may have seen with hypnosis on TV!

  • Yoga

Yoga, which is a practice of the mind and the body, has been found to decrease inflammation markers in our blood, lower blood pressure, and help in the context of IBS. The breathing during a yoga practice activates the parasympathetic nervous system (that rest and digest state) and the physical movements can help soothe the muscles and nerves in the intestine. One trial found that yoga had EQUAL benefits to a low FODMAP diet, with over 80% reporting significant improvements in their IBS symptoms. If you’ve got Dr Megan Rossi’s first book Eat Yourself Healthy, you’ll find a gut-directed yoga flow from page 172. 

Managing IBS holistically at The Gut Health Clinic

We always take a holistic approach here, considering not just diet, but also lifestyle and stressors. In some cases we wouldn’t jump to make dietary exclusions or changes at all (or perhaps very few), but instead focus on targeting the gut-brain axis through regular mindful meditation and gentle exercise such as yoga. 

Gut-brain axis work isn’t necessary for all people with IBS – many clients manage well by adjusting their diet and lifestyle with fairly simple strategies that we provide them with in clinic. However, where stress or worry is a key driver of symptoms, we may recommend the client implements the dietary intervention alongside a gut-targeted psychology service. 

IBS Treatment Package
at The Gut Health Clinic

We are excited to announce that very soon we’ll be having our very own gut-specialist Clinical Psychologist, Dr Lucy Field, joining our team. She uses cutting edge techniques to target the gut-brain axis. As the heart communicates to the brain more than the brain communicates to the heart, her technique, which is based on clinical research focuses on heart rate variability. She works with clients to improve their heart rhythms, helping them to find their optimum state for the most beneficial functioning of the nervous system, which has a positive impact on gastrointestinal symptoms and psychological well-being. We’ll be getting her to do a full post on this later this year!

If you want some bespoke advice to help manage your IBS or other troublesome gut symptoms, using both diet and not-diet strategies, contact us here.

Jo Cunningham is a gut specialist dietitian with in-depth clinical dietetic experience ranging across both NHS and private healthcare settings. Jo is experienced in helping clients to resolve gut symptoms including reflux, bloating, constipation, diarrhoea, and abdominal pain. She also specialises in the management of Irritable Bowel Syndrome (IBS) and in the use of the low FODMAP diet.

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