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March 16, 2017

How to use your brain to control your gut

Businessman with stomach acheIf the stomach is known as the second brain for the way it reacts to the world and controls our bodies, “sometimes in my field we call the brain the second gut,” said Eva Szigethy.

A faculty member in psychiatry, pediatrics and medicine, Szigethy has been focusing on how the brain affects the gut, and vice versa, for 17 years as director of the visceral inflammation and pain center at UPMC, as well as its medical coping clinic. She spoke March 1 on the topic “Using Your Brain to Control Your Gut” as part of the speaker series presented by the University Senate benefits and welfare committee’s mental wellness task force.

Our gastrointestinal (GI) tract is very sensitive, Szigethy pointed out; it has the greatest number of nerves of any organ in our bodies. “Our gut is one of the earliest indicators that we are in trouble,” she said. The body’s fight-or-flight response, caused by the autonomic nervous system, “sets off a cascade of physiological activities … that changes what we are thinking and changes what we do. This is all for us to survive.”

We may feel this as simple butterflies in the stomach when we are faced with public speaking or a “knot” in the gut when we’re about to confront a more emotional situation. “A little bit of stress can actually be helpful,” she said, because it focuses our attention on important tasks. But if stress symptoms occur too often, in response to too wide a group of stimuli, and last for too long, they can turn into pain, nausea or vomiting and cause irritable bowel syndrome (IBS), ulcers or other illnesses.

Often we self-sabotage our well-being with what Szigethy summarized as BLUE thoughts:

• Blaming ourselves.

• Looking for negatives.

• Unhappy guessing.

• Exaggeration.

The average person has 20-25 BLUE thoughts a day, she said, while the average depressed person may have 100.

“Catastrophizing … is the No. 1 driver of abdominal pain,” she said.

While research is still investigating specific causes of bowel distress and illness, whether mental or physical, there is a clearly established association between stress and GI distress, she said, with the mind further amplifying the association. Thus, there also is a link between reducing stress and ameliorating gut distress.

In fact, Szigethy said, “Most gut disorders are best treated with behavioral techniques.”

That includes IBS, which is gut pain or discomfort three days a month over three months. It can take months to years to go away, is experienced by up to 20 percent of the population, often relapses and may be a lifelong condition. IBS is one of the most common reasons people see their primary care physicians, she noted — and it can cause depression.

“It’s very, very draining to have your bowel talking to you in ways you didn’t ask it to,” Szigethy said.

Employing stress management techniques can help with IBS. That includes changing our sleeping, eating and exercise practices — and how often we simply relax and have fun.

The No. 1 thing we can do to protect our gut and other body systems is to sleep eight hours a night, Szigethy said. If you maintain a healthy sleep schedule in your 20s and 30s, you will reap the benefits in your 50s and beyond, she added.

“How, when, how often and what you eat” also affects your gut, of course, as does the amount of exercise you get. She recommended adding a half-hour of activity that increases your heart rate, three-five days a week.

She also recommended having fun as a potent stress reducer: “We need our vacations. We need to recoup. Our guts ask that of us.”

Take one or two things out of your day, each day, that reduce stress and you will see a difference in your life, she said. Schedule breaks: “I mean 10 to 15 minutes of pure release” from job duties, she explained. “Minutes can make a huge difference.”

She recommended five possible techniques:

• Take daily time outs to pursue your passions or joys, including hobbies.

• Pause in life for meaningful, leisurely conversations.

• Practice deep breathing by counting to four as you inhale, holding the breath for four and releasing the breath through your mouth for the count of eight. Practicing 10 of these breath cycles in a row “is one of the most effective ways … to re-regulate you,” she said. Eighty percent of people feel “significantly better, even doing it the first time,” she reported.

• Go to “your laughing place” by thinking of a time you couldn’t stop laughing and placing yourself there mentally.

• Repeat a daily mantra of something positive; even a positive screen saver on your phone may help.

“For about 60 percent of patients, learning these techniques and using them can be curative,” she said.

She also recommends cognitive behavioral therapy (CBT), which aims to change thoughts that may manifest as bad feelings, including painful stomach symptoms.

Both hypnosis and mindfulness/meditation can help alleviate such symptoms.

Hypnosis places us in a trance state that allows us to modify our thinking. It actually can help us create physiological changes, including changes in our brain waves, suggesting that we “tune down the intensity and quality of pain … filter out any uncomfortable sensation and substitute pleasant sensations,” she said. It can reduce pain, bloating, cramping and nausea, regulate the normal functions of your gut, and guide your brain to monitor your body without previous anticipation of bad gut symptoms “and leave the gut behind,” she said.

Practicing mindfulness, which includes meditation and other techniques, helps us pay attention to current thoughts in a nonjudgmental, accepting manner, she said, with the aim of being able to let go of stressful thoughts, as well as the anticipation or awareness of pain.

Szigethy suggested trying mindfulness during your lunch hour. “All of our guts would appreciate more mindful eating,” she said, which not only would allow us to enjoy our food but also pay better attention to signals of fullness.

Her acronym for mindfulness techniques is STOP:

• Stop and come to stillness.

• Take a breath.

• Observe and be open to present experience, thought and emotion.

• Proceed.

“Even doing this for minutes a day can be effective,” she noted.

Give these techniques a fair shot before you conclude that they are not working, she urged: “It doesn’t count as a trial if you haven’t tried something for at least two weeks, more days than not.

“Listen to your gut,” she concluded. “Our systems know what they want … We cognitively override them.”

—Marty Levine 

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