Ever had ‘butterflies in your stomach’ before going on a job interview? How about a gut-wrenching feel after watching a dramatic wartime movie?

Contrary to popular belief, these are not just adages or expressions. In fact, they have a scientific rationale behind it – this is what the experts call as the gut-brain axis.

The Gut-Brain Connection in a Nutshell

The gut and the brain might be far apart but they are connected, in the sense that the brain exerts a direct effect on your stomach, as much as gut affects your brain functions. With that being said, intestinal distress can be the result of mental issues (be it depression, stress, or anxiety) – or the cause behind them.

When you are depressed, stressed, or anxious, gastrointestinal movements are affected. These can result in inflammation or increased susceptibility to infection. Additionally, ‘stressed’ individuals seem to perceive pain in the gut system ‘even more’ than most individuals.

The Anatomy of the Gut-Brain Connection

The activities of the gut-brain axis stem from the autonomic nervous system, which regulates life-sustaining functions such as cardiac activity, respiration, blood pressure, and temperature. This system extends from the brain to the other parts of the body, and could go into ‘fight or flight’ response when a ‘stressor’ is introduced.

This gives the body the energy to face a perceived threat – so much so that other bodily activities such as digestion are slowed down, if not temporarily halted. That’s why, for example, a looming public speaking engagement can lead to abdominal pain and other functional gut problems.

Apart from the nervous system, the brain is also linked to the gut by way of immune system (through intestinal microorganisms that affect the immune response) and the metabolic system (through hormones.)

Stress Manifesting as Symptoms

As mentioned earlier, stress and other psychological problems can manifest as stomach disturbances. Having any or some of these symptoms might actually be the reason why you are not feeling any better, despite getting all kinds of traditional therapies for your gut:

• Physical: headaches, stiff neck and shoulder muscles, sleeping problems, tremors or shaking, weight gain/loss, restlessness, loss of interest in sex

• Behavioral: teeth grinding, inability to complete tasks, changes in food/alcohol consumption, increased smoking habit, rumination, procrastination, increased desire to be with people or withdrawal from others

• Emotional: crying, nervousness, depression, poor concentration, memory problems, quick temper, inability to relax, increased feeling of pressure or tension, indecisiveness, reduced sense of humor

Psychological Treatment for Gut Conditions

In cases where intestinal disorders are not cured by conventional therapies, experts advise several forms of psychological treatments. Several studies suggest that psychotherapy can reduce depression or stress, which can help bring about symptomatic improvements in people with stomach or intestinal disorders.

According to Dr. Jay Pasricha of the Johns Hopkins Hospital, psychotherapy is more effective since ‘psychological interventions can help improve the communication system between the brain and the gut.”

Good candidates for psychotherapy include:

• Those with moderate to severe functional systems who are not cured by traditional medical therapies.

• Those with gastrointestinal symptoms that are worsened by emotional issues or stress.

• Those who prefer non-drug interventions to treat their gastrointestinal symptoms.

• Those newly-diagnosed with Gastroesophageal Reflux Disease, Chronic Pancreatitis, Ulcerative Colitis, and Crohn’s Disease, among many other chronic gastrointestinal conditions.

• Those who seek assistance in coping with chronic gastrointestinal symptoms.

Should you undergo psychotherapy for chronic gastrointestinal conditions, here are the treatment modalities that the psychologist might prescribe:

Cognitive Behavioral Therapy. The goal of this treatment is to help individuals alter their behavior, emotions, thoughts, and coping mechanisms with regard to stress and anxiety.

Relaxation Therapy. This involves techniques that can help you relax and reduce your response to stress. Examples include visualization, muscle relaxation, and restful music. According to scientific research, it works best in conjunction with Cognitive Behavioral Therapy.

Gut-directed Relaxation Training. This treatment involves deep relaxation and positive suggestions that are aimed at improving gastrointestinal function. This is recommended for individuals who manifest gut disturbances despite the lack of obvious stressors.

Biofeedback. This therapy teaches the various methods that can help control automatic body responses. According to research, it can yield positive health effects when used in conjunction with other stress management techniques.

Another treatment that might be considered is the use of antidepressants, which can help moderate the activity of nerve cells in the gastrointestinal system. However, use of Selective Serotonin Reuptake Inhibitors is contraindicated as it works by increasing serotonin levels. Since 95% of the body’s serotonin is located in the gut, taking the said medication can worsen existing gastrointestinal issues.

ENS: The ‘Second Brain’ and How it Affects your Health

In the past, it was the brain’s activities that were blamed for gut problems. However, studies now suggest that gastrointestinal functions and disruptions affect brain functioning as well.

This is due to the enteric nervous system (ENS) which is comprised of 100 million nerve cells, spanning from the esophagus to the rectum. It runs on neurons and neurotransmitters similar to the central nervous system, hence the moniker ‘second brain.’

The ENS is in charge of facilitating digestion, starting from the process of swallowing to the release enzymes that break down food. It also controls blood flow that commands anywhere from nutrient absorption to waste elimination.

With these features, the ENS can control the gut by itself without any help from the ‘real brain,’ according to Dr. Michael Gershon, author of The Second Brain : The Scientific Basis of Gut Instinct and a Groundbreaking New Understanding of Nervous Disorders of the Stomach and Intestines.

The ENS also communicates with the brain, thereby resulting in big emotional changes. This interconnectivity is one of the major highlights of the branch of Neurogastroenterology, a subspecialty of clinical gastroenterology and digestive science.

According to a research paper by Wood, Alpers, and Andrews, Neurogastroenterology deals with “Psychologic and psychiatric relations to functional gastrointestinal disorders… especially in relation to projections of discomfort and pain to the digestive tract.”

Mood disruption is often seen in people suffering from Irritable Bowel Syndrome and other ailments such as stomach upset, pain, bloating, diarrhea, and constipation.

The ENS can send signals to the brain that can lead to mood changes. This, experts believe, is the reason why people suffering from IBS and functional gut problems develop anxiety or depression more than other people.

Bacteria are to Blame

Apart from the neural pathway that links the brain with the gut, the microorganisms living in the gastrointestinal tract can contribute to emotional and behavioral changes as well. A healthy and diverse gut microbiota is essential for normal cognitive and emotional processing.

Case in point: the probiotic Lactobacillus rhamnosus is capable of toning down anxiety and regulating brain function, due in part to the neurotransmitter GABA that it contains.

Expectedly, an increase in the number of harmful microbiota can lead to a deregulated inflammatory response, which in turn can affect neuropsychological functions negatively.

This was proven in a study of 46 depressed patients, whose ordure had higher levels of Actinobacteria, Proteobacteria, and Bacteroidetes, and lower levels of Frimicutes, in comparison to the fecal bacterial panel of 30 ‘normal’ individuals.

With that being said, treatment aimed at lowering the bad bacteria population – such as the use of probiotics L. helveticus and B. longum and the antibiotic Minocycline – can actually lead to depression treatment, as were seen in several studies on the effects of gut microbiota on the CNS.

More than just affecting mood, researchers also believe that bad gut bacteria can affect memory and thinking as well. A study in mice showed an infection, such as that of Citrobacter rodentium, can lead to poor cognitive thinking. This symptom, however, was reversed following probiotic treatment.

The brain-gut axis is a sophisticated two-way street, with one affecting the other and vice-versa. So before you dismiss your anxiety or abdominal pain as a ‘simple case,’ consult with your physician to see if your gut-brain connection is behind it.