“The belly is the counterpart of the face.”
William Harvey
Mealtimes were never pleasant for as long as Joyce could remember. Angry arguments between Mom and Dad were a more consistent feature of dinner than dessert. When her parents divorced before her twelfth birthday, she actually felt some relief, but shortly thereafter, she began to have frequent episodes of cramping belly pain and bloating after meals. After an extensive medical evaluation, Joyce was given the diagnosis of irritable bowel syndrome.
Now as an adult in her late twenties, eating and eliminating continue to be problematic for her. Under stress, her bowels dictate her activity and she misses up to a week of work every month. Her digestion remains so delicate she almost never goes to a restaurant with friends.
We are all aware that our emotions influence our digestion. We lose our appetite when we’re sad, get heartburn when we’re under stress, or develop diarrhea before a final exam. Our language is filled with expressions like, “I have a gut feeling,” “You make me sick to my stomach,” or “I can’t absorb what you’re telling me,” which reveal our intrinsic understanding of the mind body linkage. Although the relationship between emotions and digestion may appear obvious in daily life, science is just beginning to look seriously at this important connection.
Although the gastrointestinal (GI) tract can be visualized as a series of tubes, the transportation of food through the digestive system is far from a simple process. Muscles, nerves, and chemical messengers have to be coordinated if the GI system is to perform its essential job of extracting nourishment from the environment. Through both direct and indirect linkages, information is constantly flowing between our digestive and nervous systems.
Our gastrointestinal tract has an enteric (enterikos meaning “intestines” in Greek) nervous system (ENS) that is remarkably self-sufficient. This system, which can partially regulate and coordinate digestive activity independently of the brain, is a collection of nerve networks embedded in the gallbladder, the pancreas, and the walls of the digestive tract.1 The system includes ten to one hundred million cells organized into two nerve networks: the myenteric (Auerbach’s) plexus organizes the muscles of the gut, while the submucosal (Meissner’s) plexus coordinates release and absorption of fluids and salts. The wisdom of our body integrates these two networks to relax and contract the intestines while absorbing the nutrients necessary for our survival. Although considered a part of our involuntary (autonomic) nervous system, the ENS is actually closer in design to our central nervous system. It contains complete reflex pathways that include sensory, associative, and motor nerves that regulate muscle tone and blood vessels, as well as secretion and absorption by the cells.
Reflex circuits between different parts of the digestive tract coordinate the sequences necessary for digestion. For example, nerve connections between the gallbladder and the small intestines assist in the release of bile at the appropriate time. This neurological connection is in addition to the gut hormones that communicate information throughout the digestive tract.
The vagus nerve is the main nerve from the brain to the digestive system. Its name is derived from the same root as the word vagabond because it wanders throughout the belly. It was traditionally viewed as mainly supplying brain input to the gut, but it actually contains more nerve fibers that bring information from the GI tract to the brain. The area of the nervous system that regulates the digestive tract, the locus ceruleus (“dark blue place”), receives extensive input from the gut and is the source of an essential neurochemical, norepinephrine.2 This area has connections throughout the brain and is responsible for alertness and may also be our anxiety center. This same group of nerve cells is right next door to brain structures controlling heart rate and blood pressure. So this small region of the brain links our thoughts, digestion, and heart. Even from a purely anatomic viewpoint, we can see the intimate relationship between our mind and stomach. This connection between our brain and gut predisposes us to translate feelings into physical digestive symptoms. When we are facing high levels of stress, our guts are likely to be affected.
Alternatively, when our lives are balanced and comfortable, our digestive system is able to perform its job of efficiently receiving nourishment from the environment and eliminating material that is not beneficial. Taking in what’s nourishing and leaving behind what’s not is really the function of both a healthy digestive and psychological system. It’s not surprising, then, that if our mind is having trouble finding nourishment, our gut is having the same problem.
Chemical messengers are usually named according to the areas of the body in which they were first discovered. Transmitters first identified in the brain were called neurotransmitters, while those discovered in the digestive tract were given names reflecting their GI presence. At least two dozen peptides have been identified in the gut, representing at least fifteen major peptide families.3 Some of the common ones are listed in the table below with a few of their known functions.
| GUT PEPTIDE | FUNCTION |
| Gastrin | Regulates gastric acid |
| Somatostatin | Regulates gastrin and gastric acid |
| Secretin | Regulates pancreatic secretions |
| Cholecystokinin | Regulates pancreas and gall bladder |
| Neurotensin | Regulates intestinal motility |
| Vasoactive Intestinal | Regulates motility and |
| Peptide | secretions |
Peptide messengers can act in the gut in three different ways. (1) They can be released from one cell and carry a message to other cells very close by; (2) they can be released by one cell, enter the circulation, and act on other cells at a considerable distance; or (3) they can be released from a nerve cell and act locally as a neurotransmitter. It’s fascinating that the same chemical code can play a different role in a different circumstance, highlighting the very fuzzy divisions between the brain, endocrine, and gastrointestinal systems.
A good example of this remarkable versatility is the hormone cholecystokinin (CCK). It was initially discovered in the cells of the small intestines, where it is released into the circulation in response to fats in the small bowel. When the gallbladder receives the message of CCK, it is stimulated to contract and release its bile salts. These bind with the fats so they can be more easily absorbed. CCK is also widely distributed in the nervous system. It is present throughout the cerebral cortex, in the brain stem, and in cells that project to the brain’s limbic system, which is closely associated with emotions. CCK is also concentrated in the hypothalamus, where it plays a role in satiety and the regulation of food intake.4 It has also been identified as a pain modulator.5 Thus, this same messenger that governs a basic digestive function is involved with hunger and the feelings of pleasure associated with eating.
Another amazing transmitter that was originally discovered in the digestive tract is vasoactive intestinal peptide, or VIP. VIP was identified as one of the first new chemical messengers of the gastrointestinal system. It has been shown to regulate the secretions of the pancreas and intestines as well as the movement of food through the gut. Although named for its ability to regulate intestinal blood flow, this same chemical was discovered to influence the blood supply to the cardiovascular system, respiratory system, urinary system, and central nervous system.6 VIP is widely distributed in the brain and in nerve cells throughout the GI tract. It is also found in the skin, where it can be released through massage. Early studies suggest that massage can dilate heart blood vessels, possibly as a result of VIP release. VIP also has affinity for the same receptor on immune cells that the AIDS virus uses to enter lymphocytes.
Here again, this simple protein shows us how our arbitrary divisions between components of the mind body network are scientifically inaccurate. In reality, the body is a complex web of energy and information that uses the same chemical codes of intelligence for communication throughout the physiology.
The gastrointestinal system has been called the body’s largest endocrine organ, and it may also be the largest organ of the immune system. Considering the large amount of foreign material that enters the body through our gut, it’s not surprising that our immune system is standing guard there. The intestinal immune system is vast, with most immunocytes localized in discrete areas known as Peyer’s patches.7 There are direct links between the nerves of the gut and certain immune cells, particularly mast cells, which are responsible for releasing potent chemicals that activate the immune response.
This connection between the GI and immune systems may illuminate the role of stress on digestive disorders, and peptic ulcers provide a good case in point. It has recently been shown that a majority of patients with peptic-ulcer disease have a bacteria known as Helicobacter pylori. Although this bug makes an infectious contribution to a condition often associated with stress, it is likely that susceptibility to Helicobacter is influenced by our immune status and by levels of gastric-acid production. Both of these factors are affected by our emotional and psychological states. Studies show that Helicobacter pylori can be cultured in about three-quarters of patients with peptic ulcers, but there is a significant minority who remain uninfected.8 I predict that future studies will reveal that the state of the immune system, which is clearly influenced by emotions, is as important in the development of an ulcer as the bacteria. The brain-gut-immune linkage may explain why some people are more predisposed to developing gastric inflammation with this infectious agent than others who are immune.
Disordered bowel function is present in almost 30 percent of our population, and almost half of all patients seen by digestive-disorder specialists are eventually diagnosed with “functional” bowel disorder.9 It is estimated that this accounts for more than 1.5 million medical visits per year and the dispensing of more than two million medications.10
Functional bowel disorders comprise a spectrum of conditions in which symptoms cannot be attributed to structural problems such as cancer, tumors, or inflammation. This family of conditions includes noncardiac chest pain, non-ulcer stomach pain, simple constipation, simple diarrhea, gallbladder spasm, and irritable bowel syndrome (IBS).
IBS is the term most commonly applied to patients with digestive complaints who show no structural abnormalities when evaluated by the usual gastrointestinal diagnostic procedures. Despite its prevalence, the standard contemporary definition of IBS—“a disordered bowel habit, with or without abdominal pain, without organic explanation and of unknown etiology”—highlights our lack of understanding of this condition.11 Patients with IBS generally have a host of symptoms, primarily but not exclusively localized to the GI system. Common symptoms include: abdominal pain relieved with elimination; altered stool frequency and consistency; passage of mucus; and frequent feelings of bloating or abdominal distention.
Electrophysiologic studies show that patients with IBS tend to have abnormal intestinal motility.12 Functional bowel studies show that people with diarrhea have too many fast contractions while people with constipation have too few. Stool moves through the colon faster in patients with IBS than in people with normal bowel function. But despite these changes in the motility of the intestines, symptoms of bloating or pain are not clearly associated with times of altered bowel activity.
The most consistent finding in patients with functional bowel disorder is their increased sensitivity to pressure and distention within their gut.13 People with IBS can often detect very subtle volume changes throughout the digestive system. If a balloon is inflated in the colon of patients with IBS, for example, they will detect it at a much lower level of pressure than the average person. They will also report discomfort that includes both the belly and the lower back. They also show more sensitivity to distention of their esophagus and stomach.
Yet, people with IBS are not wimps. They are not generally hypersensitive to pain. If tested for their tolerance to annoying electrical shocks or to cold, their responses are the same as everyone else’s.14 They simply have a diminished ability to filter sensations coming from their gut. Subtle impulses, below the level of perception in most people, cause conscious discomfort in people with irritable bowel syndrome. And in addition to feeling uncomfortable, IBS patients respond with irregular intestinal contractions, resulting sometimes in diarrhea, and at other times in constipation.
Beyond their GI symptoms, people with IBS frequently have other health concerns; fatigue, chronic pain, fibromyalgia, and noncardiac chest pain are common. There may also be psychological problems, including frequent anxiety, hostility, phobia, and paranoia.15 Some of these derive from the stress of dealing with a chronic illness; others reflect the underlying imbalance in the mind body network.
Medical therapy for IBS has generally been useless, though not worthless. An evaluation for this condition usually includes both X-ray and endoscopic studies at a cost of several thousand dollars. In the vast majority of people, a structural problem is ruled out and the label of irritable bowel syndrome is applied. Medical treatment is usually symptomatic, but, because they tend to be sensitive to drugs, IBS patients often discontinue prescribed medications upon finding the side effects intolerable. A recent report reviewed forty-three studies on the drug therapy for irritable bowel syndrome.16 They looked at drugs to reduce spasm, anticholinergic drugs to slow motility, bulk-forming agents to equalize pressure, opiates to relieve pain, and antidepressants and tranquilizers to treat the associated psychological symptoms. The author concluded that “not a single study offers convincing evidence that any [drug] therapy is effective.” An interesting feature of these studies was the recognition of improvement in almost 50 percent of patients not receiving drug therapy, presumably as a result of a placebo effect.
On the other hand, several studies have demonstrated the value of hypnotherapy and relaxation training in people with functional bowel disorders. The most successful approaches are often the simplest. Patients are first taught to enter a relaxed state and then instructed to place their hands and attention on their bellies, invoking a sense of warmth. Then they are guided to imagine a healthy and relaxed functioning of the smooth muscles of their intestines.
Studies show that if you have typical IBS and practice this technique, you have an excellent chance of getting substantial relief from your symptoms within a short time with lasting benefits even after a year and a half.17,18 If you have been suffering for many years and have atypical symptoms or more long-standing anxiety and depression, there is still a good chance of some benefit from this simple procedure.
In an important study from England, people with refractory irritable bowel syndrome participated in four forty-minute hypnotherapy sessions over a couple of months.19 Almost half of the people improved and a third had almost complete relief! These were patients who had previously failed to respond to any other medical therapy. They were taught relaxation in groups of eight, making this approach undeniably the most cost-effective treatment for this condition. Combining relaxation techniques with supportive psychological therapy to identify and reduce negative thinking patterns improves both digestive and psychological symptoms.
Our gastrointestinal system is truly remarkable. Through it we ingest energy and information from the environment to create both our physical form and the energy we need to support our activities. This may be the most convincing expression of the Vedic understanding that the environment is our extended body. Nature has packaged her biological energy and information in the form of food containing the basic substrates needed to create and replenish our cells; through the process of digestion, basic codes of intelligence are exchanged between our individual and our environmental physical sheaths. Ayurveda describes the physical body as anna maya kosha, which means “the layer made out of food.” In its essence, our body really is the intelligence carried on our DNA molecules wrapped in food.
The ability to digest fully the experiences presented to us at any moment is the key to good health. When we are able to extract the nourishment we need and leave the rest behind, we create balance and integrity in mind and body. Under ideal circumstances this beautiful and dynamic process occurs spontaneously. When the mind is balanced and integrated, our appetites are strong and appropriate. Our gastrointestinal system receives healthy messages from our brain and is able to extract the elements necessary for maintaining structure and energy.
There is constant communication between our mind and gut via the nervous system. As a result of this exchange our mental state is reflected in our gut. When our emotional and psychological state is turbulent, the GI system mirrors this. One of the earliest physical expressions of emotional distress is a change in our appetite. Our loss of hunger reflects our lack of enthusiasm for any new input from the environment while our physiology attempts to process a hurtful experience. Emotional upset can also be associated with an increase in appetite, as we seek solace for our wounded feelings in food. In both cases, imbalance in our emotional body is mirrored in our digestive state.
From an Ayurvedic perspective, any attempt to create balance in the emotional body through food will be met with very limited success, because the true problems and solutions must be approached at subtler levels. Our physical sheath is the most condensed manifestation of consciousness, and therefore the most gross. Our emotional sheath exists at a subtler level, and has the capacity to influence the physical body more readily than the reverse. The ultimate healing potential is found at the level of consciousness, because everything that we create has its origins in the field of pure potentiality, beyond the many layers of our bodies, our emotions, our thoughts, and our beliefs.
We have several tools available to restore our digestive power to its natural state so that we can supply our energy and physical needs. We first need to believe at a fundamental level that we are deserving of nourishment and are not deserving of toxicity. This is true on every level of our existence—environmental, physical, and emotional. We need to assess honestly those aspects of our life that are not providing the sustenance we deserve and take steps to change them. The messages from our body are gifts that help us identify what needs to change in our life. Listening to our body—listening to our gut—allows us to tune into our innate intelligence, which can guide us along the path of greater well being.
Eating with awareness is great practice for living with awareness. When we are fully present while enjoying a meal, we efficiently extract the available nutrition and spontaneously avoid consuming that which is toxic. The Body Intelligence Techniques are cues to bring us back to present-moment awareness.
If you are having symptoms of digestive imbalance—heartburn, bloating, discomfort—use attention and intention to reestablish balance. After a quiet meditation, localize your attention to your alimentary system and visualize comfortable, smooth, effortless, balanced digestion. Eating and digesting are such primordial processes that simply remembering how natural they are can improve their function.
Use nature’s gifts to enliven healthy digestion. Enhance digestive power with spices that stimulate our metabolic fire—pepper, ginger, asafetida, wild celery seeds, cardamom, cayenne, and cloves. Simplify your diet when your digestion is delicate, pay attention to your appetite, and make certain your elimination is regular, using gentle, natural agents to restore balance when necessary.
Like the skin, the digestive tract is an area of junction between perceptions of self and non-self. When our awareness is established in the unity value of life, we view the environment as a source of nutrition—a quantum soup from which we can receive sustenance whenever we need it. But if our awareness is fixated on notions of boundaries and separation, the environment will be perceived as alien, a source of threat, and we will be distrustful of the nourishment it provides even as we seek it. Healing digestive disorders takes place when we expand awareness of our universality. From this vantage point, we can understand and experience the Vedic expression that describes food consumption as “Brahman eating Brahman”—the unmanifest field of pure awareness nourishing itself. When this state of consciousness is our internal reference point, the possibility of indigestion does not arise.
1. Follow the Body Intelligence Techniques at every meal.
2. Follow your dosha-specific dietary recommendations.
3. Pay attention to your appetite level and only eat when you are really hungry, stopping when you are comfortably full.
4. Eat an occasional meal in silence.
5. If your digestion is delicate, follow the ama-pacifying program for a couple of weeks.
6. If your appetite is weak, eat a mixture of fresh grated ginger, lemon juice, and rock salt to stimulate the agnis (one-half teaspoon fresh ginger, one-half teaspoon lemon juice, a pinch of salt) one half hour before meals.
7. If you tend to get heartburn after meals, chew a quarter teaspoon of roasted fennel seeds or a pinch of fresh coriander leaves.
8. To decrease gas or bloating, add cinnamon, cardamom, and bay to your cooking.
9. Ayurvedic herbs traditionally used to enhance appetite and digestion include sunthi (ginger), maricha (black pepper), pippali (long pepper), and ajwan (wild celery seeds).
10. Ayurvedic herbs traditionally used to quiet excessive digestive fire include shatavari (Indian asparagus), amalaki (Indian gooseberry), and Yasti madhu (licorice).
11. Ayurvedic herbs traditionally used to enhance absorption include jatiphala (nutmeg), haritaki (Chebulic myrobalan), and musta (nut grass).
12. Celebrate eating! Don’t strain.