To truly manage IBS, you need to fix the way your brain and your gut talk to each other.

When talking about irritable bowel syndrome and IBS symptoms (abdominal pain, bloating, diarrhea, constipation), the discussion is not complete without considering the gut-brain axis. Especially since IBS experts are now calling the syndrome a disorder of gut-brain interaction. It’s a fascinating subject that reminds you how everything in the body affects everything - in good and in bad. This applies also to managing IBS symptoms: it’s not enough to focus on one aspect of gut health, like your diet, but also sleep, circadian rhythms, exercise, stress, and even thoughts have to be assessed as all of these affect the gut-brain axis.

What is the gut-brain axis 

Often called the gut-brain-microbiota axis, the gut-brain axis is the communication channel between the gut and the brain, the two-directional phone line between the two.

Your gut and your brain are talking to each other all the time! The main office (the brain) wants to know what the branch office is doing (the gut) and give orders if need be. They relay information back and forth about gut processes, hunger, satiety, stress, and feelings, just to name a few. 

Problems in this information exchange are linked to irritable bowel syndrome and other “functional” gut problems, immune function, sleep problems, mood disorders, neurodegenerative diseases, and even obesity.

How are your gut and your brain connected?

It’s not simple. Many processes are involved:

• Central nervous system (brain and spinal cord): both the sympathetic (stress response) and the parasympathetic (rest response) branches of the autonomic nervous system are involved, especially the vagus nerve
• Enteric nervous system (gut’s own nervous system)
• Endocrine pathways (hormones): such as HPA-axis with cortisol (stress hormone), gut hormones like ghrelin (hunger hormone) and leptin (regulates appetite)
• Immune system of the gut: cytokines (inflammation controlling molecules)
• Microbiota (gut microbes) and the molecules they produce, like short chain fatty acids and neurotransmitters

To simplify, what you need to know is that 

• The enteric nervous system takes care of digestion, but the brain can override its functioning in stressful situations. 
• The vagus nerve is the main information pathway between the brain and the gut, and there is evidence to show that it’s not working well in people with IBS. 
• Gut microbes are highly important, and how you take care of them makes an impact on the gut-brain axis level also. 

What disrupts the gut-brain axis

It’s not completely clear how this happens, but it seems stress plays a big role, as does the health of the gut microbiota. Your gut microbes are affected by your lifestyle and your diet, both in helpful and harmful ways. It is thought that dysbiosis of the gut microbiota (negative changes in your gut microbes) can cause problems in the gut-brain axis, but it is not clear whether dysbiosis happens first, or whether the disruption of the gut-brain axis causes the dysbiosis. 

IBS can become triggered by a gut infection, which could support the idea that your gut microbe balance becomes disrupted first, but an infection also causes inflammation which the immune system controls. Gut infection is also a source of stress, and a sensitive brain may overreact to infection signals coming from the gut, starting a feedback loop that causes IBS. So, it’s not clear.

The brain then is responsible for assessing whether we are in danger or not, but your lifestyle and your diet can also affect your stress sensitivity, or how readily a stress response is triggered in the body. A typical Western diet and an irregular lifestyle with sleep deprivation could make you more sensitive to stress.

Stress sensitivity

People who have had lots of stress in their lives, whether in childhood or in adulthood, become more sensitive to stress, and are at a higher risk for developing IBS. Studies show that over time their brains have adapted to stress in an unhelpful way, which explains this increased sensitivity, and probably also why not everyone with stress has IBS.

Additionally, people with IBS tend to have these similar structural brain changes and increased stress sensitivity also, and a history of highly stressful life periods. For example, I had a client whose gut symptoms began after a serious natural disaster hit her country. This all suggests that chronic stress wreaks havoc on the gut-brain axis and promotes chronic gut issues, like IBS.

What’s more, it’s relatively common that anxiety and depression happen together with IBS, both probably feeding the other. What came first, however, is not clear. 

Looking after the gut-brain axis

Everyone can benefit from taking good care of the gut-brain axis, but this is especially important for people with IBS and other functional digestive disorders. It seems that gut symptoms are like the tip of an iceberg – your gut-brain axis may have been disrupted for a while before gut symptoms surface!

How to nurture your gut-brain axis:

• Feed your good gut bacteria with a balanced diet rich in fiber
• Support digestive processes by eating regularly, avoiding overeating, drinking enough fluids, limiting alcohol consumption
• Stimulate vagus nerve and calm the nervous system with stress releasing activities 
• Activate brain areas that lower stress sensitivity: breathing exercises, meditation
• Work on your mindset to reduce catastrophizing, expecting problems etc.
• Pay less attention to your gut symptoms
• Nurture body’s processes: keep regular daily rhythms with sleep, meal patterns and exercise, do your best to sleep well
• Perhaps specific supplements, like probiotics can help

It’s a lot! But not impossible to do. 

Strong gut-brain axis plan

The first step is to map out honestly how you are doing in these different areas listed above. 

The second step is to make a plan: what needs to change and in what order. Consider what might be easier to start with, or what might make the biggest impact. 

But you don’t have to figure this out on your own. Nurturing a sturdy gut-brain axis and relieving IBS symptoms in the process is what I do. If you are not sure, let’s chat. You will have the opportunity to tell an expert about your situation, and I will go over your best next steps without you having to commit to a program. I want to make sure you and I are a good match before you invest anything in working together. Book you free consultation here.

I hope you enjoyed learning about the all-important gut-brain axis! If you are feeling overwhelmed by this, just remember that even small adjustments to diet, lifestyle, thought patterns and stress sensitivity can make a big difference. Check out all of my free resources (scroll down my home page) - they provide lots of tips to get going with.

Thank you for reading!

PS: Book your free 30-minute consultation here!

PPS: Feeling bloated? Get your copy of the free “5 Easy Ways to Beat the Bloat” guide here!

References

1. Chen M, Ruan G, Chen L, Ying S, Li G, Xu F, Xiao Z, Tian Y, Lv L, Ping Y, Cheng Y, Wei Y. Neurotransmitter and Intestinal Interactions: Focus on the Microbiota-Gut-Brain Axis in Irritable Bowel Syndrome. Front Endocrinol (Lausanne). 2022 Feb 16;13:817100. doi: 10.3389/fendo.2022.817100. PMID: 35250873; PMCID: PMC8888441.
2. Mayer EA, Nance K, Chen S. The Gut-Brain Axis. Annu Rev Med. 2022 Jan 27;73:439-453. doi: 10.1146/annurev-med-042320-014032. Epub 2021 Oct 20. PMID: 34669431.
3. Mayer EA, Labus JS, Tillisch K, Cole SW, Baldi P. Towards a systems view of IBS. Nat Rev Gastroenterol Hepatol. 2015 Oct;12(10):592-605. doi: 10.1038/nrgastro.2015.121. Epub 2015 Aug 25. PMID: 26303675; PMCID: PMC5001844.
4. Karakan T, Ozkul C, Küpeli Akkol E, Bilici S, Sobarzo-Sánchez E, Capasso R. Gut-Brain-Microbiota Axis: Antibiotics and Functional Gastrointestinal Disorders. Nutrients. 2021 Jan 27;13(2):389. doi: 10.3390/nu13020389. PMID: 33513791; PMCID: PMC7910879.
5. Sun LJ, Li JN, Nie YZ. Gut hormones in microbiota-gut-brain cross-talk. Chin Med J (Engl). 2020 Apr 5;133(7):826-833. doi: 10.1097/CM9.0000000000000706. PMID: 32132364; PMCID: PMC7147657.

If you are wondering the answer to this question, you are not alone. There are millions of people out there experiencing gut symptoms and wondering if they should be worried about them.

The most common IBS symptoms are:

• Abdominal pain
• Bloating and/or distention of the belly
• Constipation
• Diarrhea

The way IBS is diagnosed, in order for your symptoms to “qualify” as IBS, abdominal pain must be present. It can be crampy, aching, and even quite severe. Often it is triggered or made worse by food, bowel movements and stress.

This abdominal pain is also often associated with a change in stool frequency or consistency. It typically gets better after having a bowel movement, and it would actually be concerning if it didn’t. Since abdominal pain in IBS is considered visceral pain, you’ll often feel pain in the midline of the body.

Bloating is a feeling of tightness and fullness of the abdomen, and your belly feels like it is visibly bigger, even though it may or may not be so. Distention is the term for your belly protruding more than usual with measurable increase in the abdominal circumference. People feel like they have a balloon in their belly, or that they are pregnant when they are not pregnant. Bloating and distention can cause discomfort and it may feel embarrassing.

Constipation is an infrequent bowel movement pattern, in which you have a bowel movement less than three times a week. Though it seems to me you can feel constipated even if you move your bowels daily. Constipation usually goes hand in hand with small, hard, pebble-like stools and they are hard to pass. You might feel like your bowels are not emptying fully.

Diarrhea is the opposite of constipation. It refers to loose, watery stools, more than three times per day. Diarrhea could also cause urgency - you can’t wait a minute longer to go to the bathroom or else an accident might happen.

These symptoms can be very debilitating. They might also change from day to day, one day having constipation and the next diarrhea. People experiencing IBS symptoms may feel like they need to watch closely what they eat, not stray too far from the toilet, and avoid going out to see friends, travel or eat out.

If you’ve been experiencing IBS symptoms for longer than a few weeks, or less if the symptoms are very difficult, I encourage you to go get them checked out. Then, even if your symptoms didn’t fulfill the IBS diagnostic criteria, you’d find out whether there’s something more serious going on, or whether there’s nothing to worry about. Either way, it’s better to be in the know than to be guessing!

If you have been diagnosed with IBS, but are not sure whether this is the right diagnosis, I would again encourage you to speak with your doctor. Ask how they diagnosed the disorder and voice your concerns. The end result (should be) that your doctor will either order more tests, or explain to you more thoroughly their thinking process, so that you can rest assured the right call has been made and that you can begin to apply the right therapies.

If you end up being diagnosed with IBS, or even if you’re not, I have what you need to improve your symptoms. Sign up to my IBSwise program, or if you’d like a more individualized approach, book a free 30-minute chat to discuss your next move.

Whatever you do, don’t be left alone with your symptoms! There is so much you can do to ease them.