connecting the gut and the nervous system

I had an emotional couple of days last week. If you know anything about the Enneagram personality archetyping, I’m most definitely a type 4, so deep and vast emotions are a familiarity for me. That aside, I was emotional. I cried a fair bit and felt my own little volcano of melancholy come out in periodic waves. One such wave was on a run last Thursday morning. Most long-term runners know certain runs can be incredibly therapeutic and where we work through challenging emotions. This was one of those.

When I returned to the house after finishing and began my cool down stretch, I had a familiar mild, dull pain in my abdomen set in, and it continued throughout the day. As an old familiar, I knew exactly the cause of the pain when I first noticed it. As a sensitive child, I grew up with routine anxious ‘tummy aches,’ on Sundays before a new school week began, couldn’t eat before stressful events, and generally would feel knots in my middle when emotionally distraught.

Unsurprisingly, there’s a reason for this.

For anyone that likes to show up to an athletic race early in the morning, stand in line at the porta potty, and then hope to put your best foot forward in your event of choice, or perhaps engage in a similar nervous-inducing event in another area of life like a job interview, you know that when you’re anxious, nervous, or otherwise stressed, digestion is quite a bit off. That’s because the gut and the brain are intimately connected. The nervous system has several branches and one section, the enteric nervous system (ENS), is often called ‘the second brain.’ The ENS is the section that runs through our digestive system and is connected to the actual brain through a large nerve that runs through are central body and communicates in both directions. This is called the vagus nerve.  When we have a really emotional episode, like I did, our brain can send chemical messages to the gut that change our gut bacteria, leading to low-grade gut inflammation and possibly GI distress. Similarly, if we have a particular imbalance in the gut itself—through food that doesn’t sit well or isn’t best for us, or inflammation and excessive permeability to the gut lining for another reason, we often notice behavioral changes as well. For example, persons that have chronic GI distress often also experience one or several mental health symptoms, including anxiety, depression, fatigue, confusion, brain fog, poor memory, migraines, and more.


When we have continued stress, whether in our body or in our mind, the nervous system slows down or impairs digestive function. This is why it’s best to not eat when we’re in a stressful mindset or running out the door in the morning before work or while rushing between meetings. And why one simple way to improve digestion is to single-task while we eat. That is, eat in a quiet, peaceful environment and do only that. Just eat, enjoy, and actually chew the meal. And its why major stressful life events often precede major health symptoms and then diagnoses. If you struggle with digestive conditions such as one of the Irritable Bowel Diseases (Crohn’s, Ulcerative Colitis, Diverticulitis, etc.), IBS, GERD, ulcers, chronic constipation or diarrhea, and any autoimmune disease, your condition will often respond favorably to stress-reduction techniques. For athletes with any of these conditions, we often argue that our physical activity is our source of stress reduction. That may be true—in theory—but often our activity load is contributing stress when our physical and mental systems are way out of balance.

True rest and relaxation, such as spending an hour or more per day doing absolutely nothing, deep breathing, meditation or prayer practices, spending quiet time in nature, gardening, yoga, painting, or other quiet activities without a screen are sometimes exactly what we need most to begin digestive healing – not a fancy, stressful, rigid new eating plan. (Gasp! I know; how dare I say that as someone that works with people on food!)

Otherwise, I love to work with herbs for the nervous system. In fact, nervines, the category of herbs that work on the nervous system, are by far the ones I work with and recommend the most. Lavender in this blueberry lavender smoothie bowl, and skullcap, tulsi / Holy Basil, lemon balm, and lavender in this stress-reduction tea or herbal latte are just a couple relax-inducing herbal ideas to consider.

The nervous system is one of the five primary categories of digestive imbalances I look for when working with individuals clinically. Often when we’re experiencing chronic GI distress, there will be imbalances in several categories, and we begin working on the areas that appear most pertinent. I’ll explain the other categories of digestive imbalance in future articles. And If you’re tired of dealing with your wonky GI, I invite you to reach out to me for more personalized support.

References:
1: Lipski, L. (2012). Digestive Wellness (4th ed.). New York, NY: McGraw Hill.

Carnival Belly, Running, and a Digestive Health Survey

Lately, William and I have been taking weekend adventure runs, meaning we’ve been getting out of town for a good part of the day to run somewhere new. Often this is followed by a picnic with a very runner-favorite spread: PB&J sandwiches, fruit, and tortilla chips. A couple weekends ago, the route I chose was based on being new and not far to drive, and as such it was on a course that’s designed more for mountain biking. After three miles of steady running upwards amidst the giant forest foxgloves and complete peace that is running away from civilization, we got to our summit and the single-track mountain biking descent. It started out as a really fun, fairly technical terrain with lots of creek rocks, tree roots, twisty trails and garden-gnome spotting. But there were also steady, heavy mountain biking moguls, making every bit of downhill come with nearly the same in little uphill rollers.

By about halfway through the downhill, I had this experiential memory of being on a carnival ride, and I was unsurprised to find my digestive system was feeling jostled in just the same way. By the end of the fourth and final mile of downhill, I realized I’d taken for granted that the norm for runners is to cruise and ‘wheee!’ downhill once the climbing is done. And I’d gladly take that steady climb over the tumbling in my lower GI and the muscle fatigue setting in from all those rollers.

My carnival belly largely went away for the day once I stopped running and had a meal, but it was mildly painful and upset for a day or two afterwards. Relatedly, this week our annual relay team has taken the very different challenge of racing the 2020 relay race virtually, and because this race coincides with the hottest stretches of heat year after year (and no different this year), I had that same mild carnival belly throughout the day yesterday after a hard race effort in the morning heat that was quickly becoming uncomfortable. Similarly to the week before, the discomfort was mostly gone again within a few hours.

So What’s With the Carnival Belly From Exercise, and in Running Particularly?

When we exercise, our body directs blood flow away from the gastrointestinal tract and to the working muscles. This reduction in blood flow, accompanied by an increased release of stress hormones during higher intensity or long exercise efforts, as well as the high impact of running (just visualize the internal organs being jostled up and down as we run), all combine to cause damage to the cheesecloth-thin lining to the gut, leading to all sorts of uncomfortable symptoms, as well as impaired digestion and absorption of food and drinks.

And yes, all of this is fairly normal in small amounts given the nature of doing long or hard exercise bouts. When we are dehydrated (a big topic in itself for another day) and/or exercise in the heat or to an extent that we have a high body temperature, we further reduce blood flow to the GI system, increasing stress hormone release, and develop a higher likelihood of digestive distress. But what might be a small amount of discomfort and upset sometimes should not lead to or be confused with frequently occurring and/or greater than mild GI symptoms.

Despite the serene views, this was taken at the point in the day when the sun was getting hot, the water bottle was running low, and my fun to need-to-be-done ratio was starting to tip directions.

What Can We Do For MILD GI upset?
Rather than grimace and bear it, there are many nutritional and training strategies we can do to minimize GI distress. Primary strategies include being properly hydrated in the 24 hours before / after exercising, especially in the summer heat, as well as training the gut. Just like other aspects of the body, we can train our gut to tolerate different types of foods, fuels, and amounts. Other helpful tactics include avoiding NSAIDS around exercise (as frequent use negatively impacts the gut), and eating and drinking smaller and more frequent amounts during exercise–this method alone helps alot with optimizing absorption and reducing upset.

But what about when that GI ‘offness’ or tummy upset isn’t just mild, and it continues long-term or occurs frequently?

That’s what I’d love to ask about today. Having chronic or frequent digestive symptoms including nausea, GI pain or cramping, reflux, lack of appetite (in general or after exercise), bloating, gas, diarrhea, constipation, loose stools with undigested food, or limited food choices due to reacting to many foods are all big warning signs, kind of like our body’s version of a flashing yellow or red light telling us to proceed with caution, or just plain stop and seek to understand what’s going on.

Rather than address any of those symptoms individually or all together, I’d actually first like to know how common those symptoms are–so I’ve created an anonymous survey for you to tell me about them.

If you’ve followed along here longer term, you’ll know I write about digestion a lot as it’s one of a few factors that finally pushed me into clinical nutrition, and it’s honestly my favorite nutrition topic to help others with–partly due to my own challenges over the years, but also because it can be complicated and I love a good challenge.

So if you’d please, fill out the quick survey for me and I’ll see if I can share about any of those flashing yellow or red symptoms that can cause us distress in or out of exercise in the coming weeks.

Best summer post-exercise treat / summer snacking — all the berries!

References:
Costa, R.J.S., Miall, A., Khoo, A., Rauch, C., Snipe, R.,…and Gibson, P. (2017). Gut Training: The Impact of two weeks repetitive gut-challenge during exercise on gastrointestinal status, glucose availability, fuel kinetics, and running performance.
Costa, R.J.S., Snipe, R., Kitic, C.M., and Gibson, P.R. (2017). Systematic Review: Exercise-induced gastrointestinal syndrome-implications for health and intestinal disease.
Snipe, R. (2018). Exertional heat stress-induced gastrointestinal perturbations: Prevention and management strategies.

Winter Tabbouleh and How Fiber Helps Support your Health — and Hunger

In the health, wellness, and fitness community, we often hear all about the macronutrients (fat, protein, and carbohydrates). Yet, a nutrient that’s incredibly beneficial to our health is far less mentioned. That’s fiber.

Fiber is best known to keep you regular or prevent constipation, but there are many more benefits. In the athletic community, the one that comes to mind first is helping to relieve that ‘hungry all the time’ feeling that often comes with heavier training loads. Next is gut health, lowering disease risk, and helping to regulate the body’s use of sugars.

Dietary fiber consists of the non-digestible carbohydrates from components of plants. The human body does not make the types of enzymes needed to break the bonds in these fibers, so they pass through relatively intact.

Fiber is found in most plant foods, primarily vegetables and whole grains, as well as nuts, seeds, and fruit. There are two types of fiber— soluble and insoluble.  Both are beneficial to our health.

Soluble fiber absorbs water and turns into a gel-like consistency that slows down digestion. Ever had chia pudding or chia in a smoothie and felt full and satisfied for hours? That’s the soluble fiber at work.
Soluble fiber also helps slows the absorption of sugar into the bloodstream so blood sugar levels remain more stable. Food sources include chia, psyllium, flax and other seeds and nuts, oats and oat bran, lentils, peas, and some fruits and vegetables.

Insoluble fiber is not digested by the body. It is helpful for clearing out the buildup of undigested food and environmental and metabolic toxins in the digestive system as it moves through. Insoluble fiber also helps get the digestive system moving and eliminate any constipation. (Side note: constipation is not just having difficulty having a bowel movement. That’s the extreme. It also refers to spending more than just a couple minutes on the toilet, passing hard, dry, small pieces, failing to eliminate daily, and transit time beyond 12-24 hours.) Now that we’ve got that cleared up, insoluble fiber can be found in whole grains such as oats, millet, quinoa, sorghum, amaranth, brown rice, farro wheat, beans, and fruits and vegetables.

Fiber Nourishes Your Gut

Your digestive system is home to trillions of beneficial bacteria, called the gut microbiome. They live in an (ideally) symbiotic relationship with you. This means you and they both benefit from them being there. Just like you, the microbes need to eat to live and grow, so they obtain nourishment from the food you eat. In the case of beneficial bacteria, they feed on the undigested part of the food, (fiber), that is passing through your large intestine by fermenting it into short chain fatty acids such as Butyrate.

A healthy gut microbiome can protect you against disease-causing bacteria because the good bacteria compete for space in the intestines, literally out-populating the bad bugs from taking hold. It can also help you absorb otherwise non-absorbable nutrients like certain antioxidant polyphenols, produce some micronutrients like vitamin K, and provide needed fuel for the cells in the colon. Production of short chain fatty acids by bacteria in the intestine plays an important role in the maintenance of the intestinal barrier. What’s more, Butyrate has also been shown to be protective against colon cancer.

Whereas we don’t want an overgrowth of bad bacteria, having ample and diverse beneficial bacteria is a hallmark for optimal health. Low beneficial bacteria can impact your protective mucus lining in the intestinal tract, which supports up to 80% of our immunity. The commonly used phrase “leaky gut” comes into play here when the interplay between a low fiber diet, low beneficial bacteria count, and difficult to digest macromolecules poke holes in the cheesecloth-like fragility of the intestinal lining and then opens the way for the immune system to do its job –in overdrive – resulting in sensitivities, intolerances, and allergies to many foods that are in your normal routine. Prolonged problems here are part of the pathophysiology of autoimmune diseases. 

Fiber Keeps You Feeling Full Longer – Read this again during your next heavy training cycle!

Because fiber is so difficult for your body to break down, it stays in your gastrointestinal tract longer compared to simple carbohydrates like table sugar. Having food in your system helps you feel full longer. This is partly why eating an apple is better than 100% apple juice (stripped of fiber), which is then better than apple-flavored juice (stripped of all nutrients). We even have studies showing that diets rich in high-fiber whole foods help reduce the perception of hunger. This is good information if you experience the “hungry all the time” feeling during heavy training cycles when you’re actually eating enough.

How much do we need?

Research has found that hunter-gathers ate a large quantity of fiber compared to modern humans, upwards of 100g of fiber per day. The average American has around 10-15g per day, and the US Dietary Reference Intake is around 25-38g of dietary fiber per day – which is well above that of the average person –but easily achieved by gradually increasing plant-foods in the daily routine. Can we consume too much? Yes, that is possible. Too much fiber can lead to a bowel obstruction and diarrhea (which is also caused by many other factors).

Caveats

Some therapeutic diets eliminate fiber-rich carbohydrates temporarily with the aim of improving long-term health and shifting the microbial population. For example, this is the purpose of the low FODMAP diet for small intestine bacterial overgrowth (SIBO), and the candida protocol. Individuals who try an extreme low-carbohydrate or ketogenic diet also do so with the intention of improving health –often by way of improving the body’s response to sugars. But what’s commonly left out of the conversation is that all of these diets are meant to be temporary, because they all come with long-term negative health consequences such as eliminating all those beneficial bacteria that feed on fiber.

One more thing, we often hear the advice to reduce fiber in the days before a big athletic race, or eat ‘quick sugars’ in the few hours before athletic activity. This advice largely depends on the person, since just like we can train our bodies, we can also train our gut. Some of my best marathons were run after eating my routine high-fiber dinner and breakfast. I’ll delve more into this topic soon! 😊

Summary: Dietary fiber is an essential nutrient required for proper digestion of foods, proper functioning of the digestive tract, and for helping you feel full. A deficiency of fiber can lead to constipation, hemorrhoids, and elevated levels of cholesterol and sugar in the blood. Conversely, an excess of fiber can lead to a bowel obstruction and diarrhea. Individuals who increase their intake of fiber should do so gradually since this internal adjustment is going to adjust the populations of beneficial (and not so beneficial) microbial species in the lower GI –and thus might initially come with uncomfortable symptoms.

Now that we’ve got our daily dose of nutrition wisdom, let’s eat! William labeled me the queen of grain salads the other night after presenting this dish. It’s a seasonal variation on a plethora of other fiber rich tabbouleh-like grain salads in the recipe archives of this space –and one I’m really favoring right now for the bright colors, balance of slightly sweet and savory, and all in one dish for dinner. I routinely use millet or quinoa, but used both in this version. We had a stockpile of pumpkins in our house from last season’s harvest which I’ve by now mostly used up, but I noticed at our local farmers market last weekend that winter squash and pumpkins are still going strong—locally we tend to have them until mid to late March. If they’re less available near you, swap them out for some other seasonal vegetable – or leave out completely.


Winter Tabbouleh, serves 4-6
1 small pumpkin or winter squash (about 2 cups cubed)
1 cup millet or quinoa or a combination of both
2 cups water or vegetable broth
¼ tsp. cinnamon
1 cup cilantro
½ cup mint
3 green onions
¼ cup walnuts, chopped and lightly toasted
¼ cup goji berries
2 cups cooked garbanzo beans
1-2 handfuls spinach or other greens, optional
2 Tbs. apple cider vinegar
2 tsp. honey
1 Tbs. olive oil
salt and pepper to taste

Instructions

  • Heat oven to 400 degrees F.
  • Cook millet by combining with 2 cups of water or broth, along with the cinnamon, in a medium saucepan and bring it to a boil. Turn down to a simmer, cover and cook until the liquid is completely absorbed, 25 minutes. Set aside to cool.
  • Place the squash cubes on a baking sheet with a little water. Bake for 25-35 minutes until the squash is soft. Alternatively, you can bake the squash whole until soft, then peel off the skin and chunk into pieces. This is my preferred quick-prep-ahead method lately.
  • In a large bowl, toss together the garbanzos, cilantro and mint, gojis, toasted walnuts, cooked squash and green onions. Then add the millet and spinach greens and give it all a good stir. Finish it off with the apple cider vinegar, honey, olive oil and salt and pepper to taste. Serve warm or at room temperature.