Gut-to-Brain or Brain-to-Gut?

Gut-Brain_AxisGut-to-Brain or Brain-to-Gut axis – terms I hear frequently when supervising student clinic and indeed I use in discussion with my own clients. While there is a common understanding that the brain-gut pathways are bi-directional, recent research indicates it might be important to clarify the impact of this bidirectional pathway. Does the brain have a stronger influence on the gut and creating, for example IBS-like symptoms or is the gut driving our brain, leading to anxiety, depression and mood changes? Importantly, whatever the case, does this impact on how we manage treatment?

Given the significant association with psychological conditions such as depression and anxiety, thinking has been that functional gastrointestinal disorders such as irritable bowel syndrome (IBS) and functional dyspepsia (FD) have originated in the brain and are modulated by stress pathways. That is, our thoughts and emotions drive physical stress responses, which then impact in various ways on our gut (brain to gut). However, there are inconsistencies with this understanding. For example the significant association between gastrointestinal infection and subsequent IBS points to at least a proportion of people have symptoms that originate in their gut, which can then impact on mood, leading to anxiety or depression.

Last year Australian researchers set out to determine how many people with IBS and FD have symptoms that originate in their gut (gut-to-brain) compared to those where symptoms first originated from psychological input (brain-to-gut). Findings showed that even though the pathway is bidirectional, “a major subset begin with gut symptoms first and only then psychological distress develops”, indicating that gut mechanisms are in many cases the primary starting point and cause of the gut and psychological symptoms (Koloksi, et al, 2016). The research showed that while the brain-to-gut pathway is relevant, the gut-to-brain pathway may in fact predominate and should not be overlooked during treatment planning.

Why is this important? From a naturopathic view, treatment is holistic however; the order of disease onset is significant when formulating a treatment plan. For those with a predominant brain-to-gut pathway centrally focused approaches along with psychological and mindfulness might feature strongly. Alternatively, those with a predominant gut-to-brain pathway, for example IBS that started with a gastrointestinal infection, may respond better to a focus on gut-directed interventions, with central/mood-focused approaches as supportive therapy.

Read more about mindfulness and gratitude

Read more about gut healing or constipation

If IBS or FD impact you personally and you want more information about the management of these conditions please book into make an appointment to see me or contact me here.

References:

Koloski, N.A., Jones, M. and Talley, N.J., 2016. Evidence that independent gut‐to‐brain and brain‐to‐gut pathways operate in the irritable bowel syndrome and functional dyspepsia: a 1‐year population‐based prospective study. Alimentary Pharmacology & Therapeutics, 44(6), pp.592-600.

 

Posted in IBS | Tagged , , , ,

Practicing Gratitude

Working with mindfulness practices both for clients, and myself, I have become increasingly aware of its ‘sister’ gratitude practice. Over April I participated in ‘a month of gratitude’, a concept run by a Positive Psychology program I follow. The reason I took up this month long practice was that while I conceptually understood gratitude, I didn’t find myself feeling it as often as I could.

Gratitude practice can take many different forms such as gratitude meditation or contemplation, a gratitude journal, reading about gratitude, using a gratitude app, telling others how grateful you are and the list goes on. For more ideas check out this article, which lists 26 different exercises and activities.

Studies into both mindfulness and gratitude similarly show increased levels of well-being. Unsurprisingly, gratitude practice can lead to increased feeling of gratitude and as well as long term benefits, the results can be quite immediate, bringing with it all the benefits of gratitude. For some of my clients in particular this includes more effective pain management. Other benefits include:

  • It can make you more mindful, which then brings about positive benefits of mindfulness as well!
  • Gratitude can increase sleep quality (Jackowska, 2016).
  • A three-month gratitude journal trial found that participants found things to be grateful for and were able to express their gratitude more readily, both of which had positive impacts on wellbeing, mood and depression (O’Connell, O’Shea, & Gallagher, 2017).
  • Gratitude has also been shown to increase our self-esteem and positive emotions (Amin, 2014, Rash, Matsuba, & Prkachin, 2011)

I suspect that rather than a direct benefit, improvements in mood and sleep following gratitude practice is what actually brings about positive impacts on pain. Really though, improvements in any of those areas is a positive thing.

Initially to prompt myself to practice gratitude I followed Brianna Steinhilber of everup.com and wrote down why I felt grateful but by the end of the month I found I didn’t need to journal everyday. Rather I thought about gratitude, spent short periods of time contemplating how I felt grateful and practiced gratitude in practical ways, like thanking others and taking time to just enjoy moments – walking in the local reserve, having hugs with my dog, enjoying my morning coffee (oh so much!), delighting in catching up with my mum unexpectedly etc.

I have really relished the experience of feeling grateful more often and find I tune into to things to be grateful for more readily. I didn’t always find it easy and some days I was like ‘OMG what am I going to feel grateful for today’…but the feeling didn’t last long. Overall I know it has been a useful experience for me, and I plan to continue practicing and feeling gratitude on a regular basis.

Here are some of Brianna’s prompts you can use as a tool (I particularly like this one – When was the last time you laughed uncontrollably—relive the memory):

  • List five small ways that you can share your gratitude today.
  • Write about a person in your life that you’re especially grateful for and why.
  • What skills or abilities are you thankful to have? (You communicate well, you’re a good cook, you have an uncanny ability to dominate in Fantasy Football. Hey, it’s your journal).
  • What is there about a challenge you’re experiencing right now that you can be thankful for? (This is a tough one, but you have learned something or grown from the hardship—how?).
  • How is where you are in life today different than a year ago–and what positive changes are you thankful for?
  • What activities and hobbies would you miss if you were unable to do them?
  • List five body parts that you’re grateful for and why. (Those long legs help you reach items on the top shelf … don’t forget the little things).
  • What about the city you live in are you grateful for?
  • What are you taking for granted about your day to day that you can be thankful for? (Can’t think of any? Your alarm clock, your coffee machine, the paperboy who delivered your newspaper, your friendly neighbour who always says good morning … and that’s before you even leave the house).
  • List 5 people in your life who are hard to get along with—and write down at least one quality for each that you are grateful for.
  • What materialistic items are you most grateful for?
  • Write about the music you’re thankful to be able to listen to and why. (We couldn’t make it five minutes on the treadmill without our beats).
  • Who has done something this week to help you or make your life easier and how can you thank them?
  • What foods or meals are you most thankful for? (Bacon, egg and cheese on Monday morning, we’re looking at you).
  • What elements of nature are you grateful for and why? (The beach, a starry sky or one speckled with fluffy clouds, the sunset…).
  • What part of your morning routine are you most thankful for? (A big stretch before you get out of bed, that warm cup of coffee, a cuddle session with your pet…).
  • Write a letter to someone who has positively impacted your life, however big or small.
  • What is something you’re grateful to have learned this week?
  • When was the last time you laughed uncontrollably—relive the memory.
  • What aspects of your work environment are you thankful for? (Supportive co-workers, flexible hours, great snacks in the kitchen…) (Steinhilber, 2015)

For more inspiration check out this entire article, which has 10 different Ted Talks about gratitude and below I have put down a gratitude meditation:

Email Sign Up Button [April 2013]

Posted in Gratitude, pain psychology | Tagged , , , , ,

Negative expectations of pain

It might surprise you (or not!) to know that I was the only nutritionist/naturopath at the recent Australian Pain Society conference. The attendees were largely made up of pain researchers, physiotherapists and psychologists with some GPs thrown in to the mix. The attendees were representative of the biopsychosocial approach to chronic pain and accordingly within the conference presentations there was a focus on the significant psychological influences on chronic pain.

bps model

One conference presentation examined how negative expectations and learning processes can have physiological effects and impact on central pain processing i.e. negative expectations and associated behaviours can amplify pain responses. Negative expectations about chronic pain can be formed through verbal suggestions of heightened pain (a concerned family member, ‘Don’t do that, you will hurt yourself’), prior painful experiences (see example below), and observation of pain in others. An example of this is someone with irritable bowel syndrome (IBS) who feels anxious about going out with friends because last time they ate something that triggered their IBS symptoms. The anxiety then leads to worsening symptoms regardless of food triggers in that situation. Subsequently the IBS sufferer starts to avoid social situations, creating a situation where the symptoms and pain related to IBS start to control the individual’s life and lead to a degree of social isolation. This might seem like an extreme end point however it is not uncommon for people in chronic pain withdraw socially due to anxiety or fear of heightened pain.

In situations where negative expectations play a part in creating or heightening pain responses mindfulness, cognitive behavioural therapy and hypnosis can be helpful. I also add into the mix time in nature, with animals, friends that understand what you are going through and a supportive nutritionist/naturopath who can help you de-tangle when and where negative expectations are impacting and identify what resources might assist.

Email Sign Up Button [April 2013]

 

Posted in Chronic pain management, pain psychology | Tagged , ,

Imaging Tests don’t help low back pain

Low-back-painI recently attended the annual Australian Pain Society (APS) conference in Adelaide. A commonly agreed message from presenters is that once you have chronic pain, imaging does not help. Not only are X-rays, CT scans and MRIs not helpful in identifying the causes of chronic pain, but excessive use may also put patients at risk of overexposure to harmful radiation. A study in 2010 of patients with low back pain (LBP) showed that those who had an MRI within the first month did not recover any faster than those that didn’t have imaging, however they were 8 times more likely to have back surgery.

One presenter even went so far to say that imaging is iatrogenic particularly in LBP i.e. that it helps create chronic LBP. Why? In chronic low back issues pain is not a measurement of tissue injury – we just think it is. Degenerative changes are frequently seen on images however are commonly asymptomatic and generally a normal sign of ageing. As a rule of thumb images do not explain chronic pain and spinal imaging is not associated with LBP prognosis. The concern stems from how image findings are reported back to the patient. Poor communication about what is seen may lead to increased fear of re-injury and as such decrease the likelihood of a good outcome. Unfortunately poor communication is common. However, for want of a solution, health practitioners and their patients in pain still frequently use and request imaging as part of a LBP work up.

Take home message: if you have chronic LBP, imaging won’t help identify the cause of pain and may increase the risk of surgery! Try a more conservative approach of physical therapy, exercise, appropriate nutrition and mindfulness.

Reference:

Webster, B. S., & Cifuentes, M. (2010). Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes. Journal of occupational and environmental medicine, 52(9), 900-907.
Posted in Chronic pain management | Tagged , , , ,

Kitchen Table Wisdom

Come and see me talk about ‘Real Food for Real Nutrition’ at the inagrual Kitchen Table Wisdom event.

Kitchen Table Wisdom Flyer 1 22nd April 2017

Posted in Health Tips, nutrition, Uncategorized | Tagged , , ,

Sleep Deprivation & Chronic Pain

sleep

Sleep & Chronic Pain

In this podcast with Audra Starkey aka The Healthy Shift Worker I talk about how chronic pain is essentially an oversensitive nervous system response. I also discuss how sleep and pain are bio-directional, meaning pain can disturb our sleep and vice versa, along with the correlation between lower back and low vitamin D levels. Thanks to Audra for having me on The Healthy Shift Worker – it was heaps of fun.

Listen to the podcast

Posted in Chronic pain management | Tagged , , ,

A quick F&V fix!

carrot

Positive mood and more motivation from eating vegetables

Is two weeks soon enough to start feeling better? Yes according to a recent paper of which the title is in part “Let them eat fruit!” reported that increasing fruit and vegetable consumption for just 2 weeks is enough to start seeing and feeling positive benefits. Young adults taking part in the reported trial experienced motivation, positive mood and increased vitality.

Before taking part, participants ate 3 or less servings of combined fruit and vegetables a day, a similar average daily consumption of many Australian adults. Groups within the trial were either provided with fresh seasonal fruit and vegetables or sent twice-daily texts encouraging them to consume more fresh produce.

Interestingly, text messaging didn’t work but by contrast, ready availability of produce did, with consumption increasing along with blood levels of vitamin C and carotenoids (a plant nutrient found in orange and red vegetables).

While this trial was conducted on young adults, I think the take home message is the same regardless – if there is a ready supply of fresh seasonal produce in the home, it is more likely to be consumed. I can say from personal experience that this approach works for me, and not just at home. Recently during ‘O-week’ at the college I teach, there were bowls of Granny Smith apples supplied in ready abundance for students. I admit, in passing, I poached at least one every day, as did many students and staff members I saw munching on apples over that week. Providing access to fresh seasonal fruit and vegetables could also be applied to the work place environment, schools and universities alike. A few ideas I have seen work or strategies I have used myself to increase easy access to fruit and vegetables include:

  • A weekly delivery of fruit and vegetables delivered to the home – for me this is a convenience I value. I also have to get creative with my cooking, as the box is varied and seasonal.
  • Fresh fruit/plant based meals in vending machines. There is a healthy vending machine at my workplace, which I know the students take advantage of. The fresh, daily produced meals look delicious.
  • Rallying schools to include more fruit and vegetable based options in canteens. Jamie Oliver has really championed this push and it would be great to see it more widespread in Australia.
  • Supermarkets giving away fresh fruit to children in the F & V section of the supermarket (I love this idea as it also reduces food waste).

Reference:

Conner TS, et al. Let them eat fruit! The effect of fruit and vegetable consumption on psychological well-being in young adults: A randomized controlled trial. PLoS One. 2017 Feb 3;12(2):e0171206.

Posted in nutrition | Tagged