Brain-gut connection explains why integrative treatments can help relieve digestive ailments

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During the 20th century, medicine became very good at compartmentalizing different systems of the body in order to understand them better. However, today we are increasingly realizing that different systems of the body are interconnected and cannot be completely understood in isolation. The brain-gut connection is one very important example of this phenomenon.

Anatomy of the brain-gut connection

What exactly is the connection between brain and gut? The brain sends signals to the digestive, or gastrointestinal (GI), tract via the sympathetic (“fight or flight”) nervous system and the parasympathetic (“rest and digest”) nervous system. The balance of signals from these two inputs can affect the speed at which food moves through the digestive system, absorption of nutrients, secretion of digestive juices, and level of inflammation in the digestive system.

The digestive system also has its own nervous system, the enteric nervous system, consisting of approximately 100 million nerve cells in and around the GI tract. The enteric nervous system receives inputs from the sympathetic and parasympathetic nervous systems but can also function independently of them.

The enteric nervous system is also intimately interconnected with millions of immune cells. These cells survey the digestive system and convey information, such as whether the stomach is bloated or whether there is infection in the GI tract or insufficient blood flow, back to the brain. Thus, the brain and GI system communicate with one another in both directions.

Effects of stress and negative emotions on the gut

Because of this strong brain-gut connection, stress and a variety of negative emotions such as anxiety, sadness, depression, fear, and anger can all affect the GI system. These triggers can speed up or slow down the movements of the GI tract and the contents within it; make the digestive system overly sensitive to bloating and other pain signals; make it easier for bacteria to cross the gut lining and activate the immune system; increase inflammation in the gut; and change the gut microbiota (the types of bacteria that reside in the gut). That’s why stress and strong emotions can contribute to or worsen a variety of GI conditions such as inflammatory bowel disease (Crohn’s disease and ulcerative colitis), irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and food allergies and sensitivities.

The negative changes in the GI system can then feed back on the brain, creating a vicious cycle. For example, new research is demonstrating that increased gut inflammation and changes in the gut microbiome can have profound effects throughout the body and contribute to fatigue, cardiovascular disease, and depression.

Mind-body approaches to GI ailments

Given this strong mind-body/brain-gut connection, it should come as no surprise that mind-body tools such as meditation, mindfulness, breathing exercises, yoga, and gut-directed hypnotherapy have all been shown to help improve GI symptoms, improve mood, and decrease anxiety. They decrease the body’s stress response by dampening the sympathetic nervous system, enhancing the parasympathetic response, and decreasing inflammation.

Other integrative approaches

We’ve also learned that certain kinds of foods can trigger specific reactions in the gut of sensitive individuals. In those cases, specific diets, such as low-FODMAP for IBS or avoiding acidic foods for GERD, can be helpful for managing symptoms. Diet also profoundly affects the gut microbiome. For example, eating a more plant-based diet with few refined carbohydrates and little or no red meat often leads to a healthier microbiome. These dietary changes in turn reduce intestinal inflammation and may help reduce systemic symptoms such as fatigue or depression and the risk of cardiovascular disease.

Although each person’s situation is unique, I often find a combination of integrative approaches can be helpful for reducing GI symptoms and reestablishing both a healthy gut and a healthy mind.

Follow me on Twitter @DrCalm123

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Can you strong-arm diabetes?

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There is a strong link between diabetes and fitness. Many studies have shown that people with type 2 diabetes lose more muscle mass and strength over time than people with normal blood sugars. This is thought to be a major reason why diabetes is associated with functional limitation, impaired mobility, and loss of independence. Studies have also shown that combining aerobic and resistance training can not only improve blood sugars in people who have diabetes, but can also prevent diabetes from developing.

For these reasons, scientists are very interested in the relationship between diabetes and fitness, teasing out the differences between muscle strength and cardiorespiratory fitness.

In a 2019 study published in the journal Mayo Clinic Proceedings, researchers looked at 4,681 adults, measured their muscle strength and cardiovascular fitness, and followed them over about eight years. Both upper and lower body muscle strength were measured using bench and leg presses at increasing loads, and participants were scored as having low, medium, or high strength based on the maximum weight lifted per kilogram of body weight.

They found that those with medium strength had a 32% reduced risk of developing diabetes than those with low strength. This is all fine and good and consistent with prior research. However, they did not see that those with high strength had any further reduction of diabetes risk. As a matter of fact, there was no association at all.

How could this be?

The authors focus largely on the also very important cardiorespiratory fitness factor. They point out that those participants with medium strength also tended to have good cardiorespiratory fitness, with good correlation between the two. However, in the low and high strength groups, it was a bit of a mix, with some people in the low strength group having high cardiorespiratory fitness, and vice versa. They point out that there may be added benefit to having both good muscle strength and good cardiorespiratory fitness, not just good muscle strength alone.

But another consideration is how things like strength and cardiorespiratory fitness are measured. It’s important to note that just about every study looking at muscle strength uses a different method than this study. Hand grip strength is very common, for example. One large 2018 study of 8,208 Korean adults found that stronger hand grip strength was significantly associated with lower fasting blood sugars, HbA1c levels, and fasting insulin levels (all markers of prediabetes and diabetes). It’s possible that hand grip is somehow a superior method of measuring strength than bench and leg press, or vice versa.

Maybe cardiorespiratory fitness is the more important factor after all?

This has been found to be particularly important in diabetes prevention. One large 2018 study out of Japan looked specifically at cardiorespiratory fitness (as measured by oxygen uptake while exercising on a cycle ergometer) in 7,804 men, and followed them over about 20 years, checking several times to see if anyone developed diabetes. They found that higher cardiorespiratory fitness was significantly associated with lower risk of developing diabetes at all follow-up periods. This is a pretty powerful association, though it would be good to do this study in women and in other ethnic groups.

Let’s look at the big picture

Being in good overall shape, meaning having both decent muscle strength and cardiorespiratory fitness, is just good for you. Both can very likely lower your risk of developing diabetes, and even if you have diabetes, being fit can improve your blood sugars.


Association of Muscular Strength and Incidence of Type 2 Diabetes. Mayo Clinic Proceedings, March 11, 2019.

Accelerated Loss of Skeletal Muscle Strength in Older Adults with Type 2 Diabetes. Diabetes Care, June 2007.

Patients With Type 2 Diabetes Show a Greater Decline in Muscle Mass, Muscle Strength, and Functional Capacity With Aging. Journal of the American Medical Directors Association, August 2013.

Muscle dysfunction in type 2 diabetes: a major threat to patient’s mobility and independence. Acta Diabetologica, December 2016.

Effects of Aerobic and Resistance Training on Hemoglobin A1c Levels in Patients with Type 2 Diabetes. JAMA, November 24, 2010.

Association between muscle strength and type 2 diabetes mellitus in adults in Korea. Medicine, June 2018.

Long-term Impact of Cardiorespiratory Fitness on Type 2 Diabetes Incidence: A Cohort Study of Japanese Men. Journal of Epidemiology, May 5, 2018.

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Easy daily ways to feel more connected

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I’ve got some legitimate skills: in no particular order, making pesto, finding lost LEGO pieces, and having debates in my head. That last one might be my specialty. I work for myself and by myself, tumbling around thoughts and words all day. But it doesn’t stay at my desk. I get into internal beefs, turning imagined conversations and arguments over and over. I need to find ways to pull out of my head, to feel more connected and less isolated every day.

Getting out of your head

One difficulty is that it’s normal to be in your head. “It’s always there and comfortable. It’s reassuring to you and makes you feel good,” says Sara Lazar, PhD, assistant professor of psychology at Harvard Medical School. “We all have that voice. The problem is that voice is a distraction and drowns out everything else.”

Engaging with others challenges your assumptions, she says. It forces you to say, “I never thought of that.” Also, it diminishes some loneliness.

“You feel heard, seen, and respected,” Lazar says. “It helps the other person feel connected to you, and with that, you feel less disconnected from the world.”

Forging a connections

A couple of years ago, I experimented with saying hi to 10 people for 10 days. It worked beautifully. People became three-dimensional. The place I live felt warmer and I felt more a part of it. I still try to keep it up, just to remain engaged. And I looked for other chances to feel more connected and less isolated with help from two experts.

Thank people. Whether it’s the bus driver or a person holding the door — which could be you as well — thanking people recognizes their existence and that things don’t magically happen. “It reminds us we live in the interconnected universe,” says Sharon Salzberg, co-founder of the Insight Meditation Society and the author of Real Happiness: The Power of Meditation. Pick up a conversation. If a person puts out a verbal fist bump, don’t let them hang. Again, they feel visible, a good feeling to have, Lazar says. More than that, conversations beget conversations that beget commonalities. “It makes the world bigger but more intimate,” Salzberg says. Take note of three things to appreciate throughout each day. People are wired to scan for threats, a necessary skill to avoid being eaten. But not everything is predator or prey. Having a different target reorients your perspective. “It focuses on what we do have rather than what we don’t have,” Salzberg says. Connecting: The simple part and the challenge

None of these are complicated, but that’s not the challenge. “It’s not hard to do. It’s hard to remember to do,” Salzberg says. People get frustrated, anxious, tired. The phone and earbuds are attractive escapes. It takes a strong intention, and possibly technological assistance –– setting reminders on your computer or phone –– to create a habit.

These tips from Lazar can help smooth your path:

Do what feels comfortable. Or more specifically, do what doesn’t feel wholly uncomfortable because there’s always a fear of the unknown. It could be saying hi to 10 people, but five or even just two might be more realistic. “It’s baby steps,” she says. “Start with where you are and what works for you.” Play interactions out in your head. What’s the worst realistic thing that could happen? The person doesn’t say hi? Snaps at you? After you imagine the possibilities, they can feel less overwhelming. Begin with friendly faces. This can be people whom you know a little or people who work in customer service. You can sense who might be more receptive. “Start in the bath, not the ocean,” Lazar says. Connecting creates ripples

And here’s one more thing to remember: a response isn’t guaranteed. People are shy, dealing with their own problems, or just might not be ready. You also might not be into it at every moment. I recently didn’t pick up a conversation because I didn’t feel like talking about plastic cups in the ocean at 7 a.m. at the gym. But it’s a big-picture pursuit. That person who didn’t respond yesterday might tomorrow. Someone who saw the attempt could be motivated to connect with someone else.

“There are ripples,” Lazar says. “What you’re trying to do is build up your muscles so it becomes a habit. You’re not going for a perfect score.”

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