While having IBS or another gut disorder puts your digestive tract at center stage, as we discussed in Chapter 2, your brain plays the supporting—but crucially important—role. It’s sort of like when you get the dreaded “spinning wheel of death” on your computer (you know, the multicolored swirl that tells you “something does not compute”). You can clearly see that there’s a problem on your screen; however, it’s something deep inside the computer’s programming that’s making it freak out on you rather than the screen itself.
Communication from your brain to your gut works similarly to a never-ending group chat with your bestie: Your brain sends your gut messages, and your gut sends messages back, often at the same time. This channel—the Kik of your body, if you will—is called the gut-brain axis. Nerves that line the wall of the GI tract record information about how your gut is working and send the messages through the spinal cord and up to the brain. At the same time, the brain tells the gut how you’re feeling emotionally—how stressed or relaxed you are, what you’ve been thinking about, and what’s going on in other parts of your body. You tell your friend what’s going on with you. She tells you how she’s feeling. Sometimes you listen closely and respond to each other’s every word. Other times you just keep yapping about your own day. But you’re always, always talking—just like your brain and your gut.
A person with IBS, it seems, may have a more active Kik chat than a person with a healthy gut. Whether motility—how quickly things move through the GI tract—is too fast (leading to diarrhea) or too slow (resulting in constipation), a person with IBS typically has more sensitivity to those sensations. As a result, the messages that get sent to the brain have way more angry-face emojis than those of a person without IBS.
There was a time when a person with IBS might hear from their doctor, “It’s all in your head.” Of course, now we know that there’s much more to this debilitating disorder than not being very good at managing stress (you probably know this by now, but if your doctor says it’s all in your head, it’s a great time to find a new doctor). However, there’s no doubt that emotions—while not the cause of GI disorders—can play an important role in managing their symptoms. Of the teens and young adults that I interviewed for this book, 75 percent said that stress had a negative impact on their gut issues.
This book, of course, is all about doing everything you can to manage your condition. Just saying, “This sucks” doesn’t help (even though it does suck—it truly, truly does—and sometimes you do need to get that off your chest). This is why I thought it was so important to give you ways to help smooth out the connections across that gut-brain axis. Brain-focused strategies are yet another tool you can have in your backpack—along with food and whatever probiotics, supplements, or medications your doctor suggests—to help you live your best life. Following are some stress busters for you to explore.
“I regret that workout,” said no one ever. OK—so I got that off some motivational fitness person’s Instagram. But it’s true, I believe. Getting started with exercise is the hardest part. But once you’ve done it, you’ll be so glad you challenged yourself, every time.
While the word exercise itself might conjure images of moms in workout gear or sweaty dudes from the football team getting ready for the big game, all it means is simply “activity requiring physical effort.” In other words, the definition is pretty wide open—meaning everyone can find a form of exercise that appeals to them.
You’re probably already aware that exercise is good for health in general. It strengthens your bones and muscles, boosts your immune power, helps keep you at a healthy weight, and is nature’s best mood booster—the act of raising your heart rate causes the release of chemicals called endorphins, which work by activating receptors in the brain that reduce the perception of pain and just make you feel good. Breaking a sweat also helps diminish the release of stress hormones.
Between making you less sensitive to pain and curbing your nerves, it makes perfect sense that exercise could be a strategy in managing gut symptoms. When researchers in Sweden asked thirty-nine adults with IBS to increase their exercise level for twelve weeks, more than half had a reduction in symptoms; participants also went on to experience less depression and anxiety, and a better overall quality of life.
So what counts as exercise? Anything you can do that bumps your heart rate up for an extended period of time. How much should you get? Experts say teens (up to age seventeen) should aim for at least sixty minutes a day, five days a week; adults thirty minutes a day, five days a week. For some people (especially those who play sports), that comes naturally. For others, it seems totally unattainable—especially if gut problems have been getting in the way of your getting active.
If you’re one of those people for whom exercise isn’t already a regular part of your life, here’s what I believe you should aim for: more. Don’t get intimidated by recommendations to work up a sweat for at least an hour every school day. Maybe fifteen minutes a day is totally challenging for you. So that’s where you start. When you get comfortable with that, strive for more.
Ommmmmmm…. Excuse me, I heard the word meditation and immediately felt more relaxed. You see, meditation might sound a little “woo-woo,” but it has proven benefits that give it plenty of credibility. Research shows it can help us better manage pain and stress—so it should come as no surprise that it can also help with gut problems.
When people with IBS took a class that focused on how emotions connect with symptoms (as you’ve learned in this book!) and taught relaxation and meditation techniques (and instructed participants to use them for fifteen minutes twice a day), they felt they had fewer symptoms and a better quality of life and were happier than people who didn’t participate. Another study asked one half of a group of people with inflammatory bowel disease to take a meditation workshop and put what they learned into practice, while the rest of the group took an educational seminar. Seven months later, the meditators had decreased their levels of C-reactive protein, a marker of inflammation in the body, while the people in the educational seminar stayed the same. Participants also reported fewer symptoms and said they felt better emotionally.
Convinced? Not quite? Here’s my final selling point: Meditation is free, doesn’t have to take up a lot of your time, and you can do it anywhere—and no one needs to know. Get started by going to a website like the UCLA Mindfulness Awareness Research Center (marc.ucla.edu/body.cfm?id=22) or downloading an app for your smartphone like Calm or Headspace; all will walk you through exercises that will help you slow down and breathe, and maybe even diminish your symptoms.
While most types of yoga may not get your heart pumping in quite the same way an uphill run would, it’s a better workout than you might think (although there are some exceptions; vinyasa and power yoga are two examples). If you’ve never taken a yoga class, you may have preconceived notions about twisting your body into complicated contortions. But yoga isn’t just about being a human pretzel. It’s a sequence of bends and exercises that help you link your breath to each and every movement. One of my former yoga teachers always called it meditation in motion, which sums it up well. As you move your body, you learn to breathe, calm down, and let go.
Because exercise and meditation both have gut-health benefits, yoga, which essentially combines the two, is a winning option for you. When researchers at UCLA asked fourteen- to twenty-six-year-olds with IBS to take a yoga class twice a week for six weeks, nearly half reported a decrease in stomach pain, while around one third had a significant improvement in overall symptoms.
Bottom line on yoga: It’s not a magic bullet, but there’s a chance it may help—and it’s great for other reasons, too. Research has linked it with helping teens manage emotions, improve self-esteem and attention span, and even get better grades! No harm in trying.
Many of the teens I’ve spoken with about their experiences managing gut problems said that talking with someone who cares—a friend, relative, school counselor, or psychologist—was a big help to them. A review of forty-one studies from Vanderbilt University that looked at how well therapy helps digestive symptoms in adults with IBS supported the idea that talking can help decrease suffering and showed that the effects can last over the long term.
While it’s fantastic if your mom, sister, or best friend can be that sounding board, I highly recommend talking to someone whose job it is to listen, like a psychologist or social worker. Professionals are trained in how to help people; they also take care to leave their feelings out of it (unlike a parent, who might have great intentions but feels wracked with guilt for passing the “bad belly” gene down to you). Another bonus is that the time with a therapist is your time—she won’t be distracted by work deadlines or friends texting like a relative or friend might.
Remember, too, that there are real links between gut issues and conditions like depression, anxiety, and eating disorders. Having a GI issue doesn’t mean you’ll become depressed, of course, but you’ve undoubtedly got a lot on your plate—so there’s every reason for you to take your emotional well-being seriously and make sure you are getting all the support you can.
I must admit, I thought gut-directed hypnotherapy sounded a little wacky until I did some digging and found that there really is something to hypnotherapy—a.k.a. hypnosis—when it comes to managing gut symptoms. Hypnosis is a mental state in which a person is highly responsive to direction, and it naturally slows digestive function; a trained practitioner can use it therapeutically to help a patient decrease stress and improve GI function. A review article from Australia’s Monash University reported that six out of seven studies on hypnotherapy found significant reductions in the uncomfortable effects of IBS, which were often maintained long after the hypnotherapy sessions ended. They also noted that it seemed to help patients with ulcerative colitis stay in remission from their symptoms.
So how do you find a certified hypnotherapist who will help you calm your gut and not make you cluck like a chicken? A good place to start is the American Society of Clinical Hypnosis (ASCH), a professional organization that requires members to have a graduate degree in a related health care discipline, a license or certification in the state in which they practice, and forty hours of approved hypnosis training, among other criteria. Their website, asch.net, can help you locate a practitioner in your area; your gastroenterologist or registered dietitian nutritionist may also be able to connect you with a practitioner she knows and trusts.
Biofeedback is a technique that trains people to control normally involuntary bodily functions like heart rate, blood pressure, and muscle tension. A therapist connects you to (painless) electrical sensors that receive messages about what’s going on inside your body. As a signal like beeping or a flashing light briefs you on your inner workings, you work to change the way you think, feel, and act in order to change those rhythms. Research shows that biofeedback may be effective in people with constipation-predominant IBS, helping them to relax their pelvic floor muscles.
Because anyone can perform biofeedback in most states, it’s important to make sure your biofeedback practitioner has adequate training and experience. Again, ask your GI doc or registered dietitian nutritionist if he has a trusted professional to refer you to. If not, the Biofeedback Certification International Alliance (bcia.org) is a professional organization that keeps a database of certified practitioners; make sure anyone you use is experienced in gut disorders as well as certified to provide biofeedback services.