Irritable Bowel Syndrome: It’s All In Your Head

Dr. Sonya Nobbe, ND

One of the most frustrating outcomes of an IBS diagnosis for many patients is the common judgement that “it’s all in your head”. If group hypnosis and “psycho-education” studies demonstrate positive benefits for people with IBS, then this must be true, right? Here’s a little bit of what “all in your head” means to me.

IBS is a “diagnosis of exclusion”, which means that to the best of our current medical knowledge, all causes of digestive pain have been ruled out, and there is no known cause for the pain. In fact, there are many additional causes of digestive pain involving seemingly unrelated systems in the body, including the nervous system (the gut makes more serotonin than the brain), endocrine system (there are many estrogen receptors on the gut, which is why many women experience symptoms only during certain times of their menstrual cycle), and immune system (which generates inflammation when “danger” is perceived).

This past decade has seen a substantial amount of scientific research about “the second brain”. The gut contains its own huge nerve network that can amazingly work independent of the brain. It connects to the brain largely through the part of the nervous system that works when a person is relaxed (i.e. the parasympathetic nervous system). If a person is in “fight or flight” mode (i.e. when the sympathetic nervous system dominates), the stomach has difficulty functioning and the result can be painful. The “fight or flight” state historically was activated substantially only when a person was in danger. (A body is meant to run from danger… Not sit down and enjoy a meal!) Current lifestyles as they are however, many of us exist in a chronic state of heightened awareness or “stress”, whether from our jobs, relationships, busy lifestyles, and constantly being “plugged in” with our phones and computers.

But “stress” comes in many forms; it isn’t always emotional. Our bodies can be in this “fight or flight” mode from physiological stress, including from inflammation caused by food intolerances, bacteria imbalances in the gut (please see the article on probiotics, above), undiagnosed parasitic infections, lack of oxygen (hypoxia), and muscle or joint pain. Some people with IBS experience significant relief when certain foods are eliminated, specific probiotic strains are used, breathing techniques are adapted, and osteopathic or massage interventions are used to help align the spine and muscles that contribute to an optimally functioning gut. Certain forms of Reiki can also support a healthy sympathetic-parasympathetic balance in the body and digestive function, and even mindfulness meditation is known to reduce inflammation in the body, possibly by its beneficial impact on the nervous system.

The idea that digestive pain is “all in your head” is, in my opinion, an unfortunate consequence of a culture that lacks respect for the mind-body connection. Our science would rather believe that a placebo effect, in which perhaps 20% (or more!) of people in a research study improve with no intervention but positive thinking, is a negative reflection on the drug or product being studied, rather than a positive reflection on the capacity of the mind to heal the body. The fact that IBS symptoms are largely affected by stress can be considered quite the advantage since pain can be reduced significantly for some people by learning to incorporate simple stress reduction techniques into their daily routine. Furthermore, if addressing stress at the level of the mind doesn’t provide enough pain relief, there are many ways to address physiological stress and corresponding pain with any one of the numerous healthcare modalities offered at KIHC or elsewhere in Kingston.