Welcome to the final instalment of our stress series. The gut is arguably one of the hottest topics in health at present. From the gut microbiome, to the role of fibre in feeding the microbiota, there’s a plethora of conversation happening around this significant chunk of our physiology. Yet one thing remains notably absent from the conversation: the fact that the gut houses our enteric nervous system, the gut brain (if you will), and it is inextricably linked with the rest of our nervous system via the vagus nerve. Ever had a gut feeling someone was a foe rather than a friend? That has a significant effect on your gut and brain function. It can create a sympathetic response that is fight or flight ready and put you in a state of being temporal/occipital dominant and thus more anxious.
It’s time we started to broaden the discussion around nurturing the gut, and talking about how it links with the central nervous system. We caught up with Dr Michael Hall, of BrainDC, to talk about it. Educator, researcher and clinician, Dr Michael Hall is a big picture kind of thinker. Within minutes of talking to him, you realise you can’t separate one part of the body and only talk about that. The gut links to the brain, which links to posture, social connectedness, exercise, heart rate, stomach acid, stress, and a million other things, all of which can create either afferent or efferent feedback to the brain. So when we ask a simple question like “How do we nurture the gut brain?” the answer spans a plethora of considerations.
At the heart of it though, it comes back to a single word. Empathy. How do we get there? Grab yourself a cuppa. We are in for a ride.
“The problem in health care is that we are asking questions we already intuitively know the answers to,” says Dr Hall. “Do we need research that says ‘You have two legs, you should probably walk?’ Everything about child’s motor and cognitive development is about being able to walk upright by one year old. If your child isn’t walking by around one year old, there may be a problem in development.
“If I have a kyphosis of the cervical spine, what does that tell you about the right prefrontal cortex [which is involved not only in posture, but in our sense of love, empathy, and the feeling that everything is going to be okay, which then impacts our mental wellbeing]? What does that tell you about the development of posture and fine motor skills? What does that tell you about the mental state?”
So, the cervical kyphosis isn’t just about posture and motoric skills. Our posture is a reflection into the state of our health impacting cognition, mood, autonomic regulation and wellbeing. This brings us down to the gut brain.
“Once when I saw you, I had a feeling – Were you my friend? Were you my foe?” explains Dr Hall. “This puts into place the activation of either my amygdala or my frontal lobe. If you are a friend, it’s more about my frontal lobe and I’m calm, cool, composed and receptive. If I think you are a foe and that you might bring harm to me either physically or emotionally, I’m guarded. And it’s my amygdala that takes over. My sympathetics take over, my heart rate elevates, my pupils dilate slightly, my gut temporarily shuts down, and my flexor muscles become more contracted. When you are in this alarm state for long periods of time your gut becomes altered both in flora and function. The vagal nerve is the primary nerve regulating digestion and gut regulation. The same nerve that affords us the decision making between “friend or foe”.
The top 3 stressors worldwide are each related to or directly involve finance, work and relationships.
When you look at divorce in the US, the number 1 cause is finances. Now, generally speaking, look at this from a man’s perspective versus a woman’s. Be careful to understand that it’s not “man v. woman” but rather the male and female brain have physiologic and anatomic differences. The number of neurons, the number of connections, and how we are wired are different. We are also influenced by our past experiences and future expectations. Men may feel like they can’t make enough to provide for the family [and that’s a stressor to him], the spouse however may just want them to be home rather than work all the time. Some women may prefer to be home once they begin a family but feel “pressured” to return to work to help with family finances. That’s a stressor to her. They need the social connection, but now they can’t pay the bills. So she goes to work and feels guilty because she can’t be home with the kids.” These are difficult topics to discuss and it’s not really about gender roles and identities, and man vs. woman, but rather how the individual is perceiving the situation, the environment, and reflecting on how they see where they are at the moment and how they think the future will be. Thus a lot of individuals live in a state of alarm physiology, anxiety / depression which ultimately takes a toll on many aspects of health, especially our gut.
There is a circle of stress here – money, relationships, and money again. But how does this impact the gut brain?
“An underlying theme is vagal tone. If we look at vagus from a basic science perspective there is a supradiaphragmatic vagus or a smart vagus – that is heart and lung innervation – which is linked back to your frontal lobe which is linked to how you perceive each other. So if someone you don’t care for walks into the room, you perceive a threat. The gut shuts down, heart rate and respirations increase. Imagine having dinner with a “foe”.
The myelinated vagus then drives the unmyelinated vagus, which is your gut. Therein lies the majority of your immune system. We have to have adequate vagal tone in order to have an adequate immune system. This is a case of ‘good mind, good body’. If the smart vagus perceives a threat, then it shuts the unmyelinated vagus down.
There is the gut-brain connection. There is the Myelinated and Unmyelinated Vagus and they turn on and off. There is feedback to the brain, so this links to heart rate, which links to stomach acid. The Smart Vagus tells the brain to shut down Vagus. This turns on the sympathetics. When you turn that on and the Unmyelinated vagus off, you allow there to be leaking of the pyloric sphincter which can allow proteins that are not absorbed into the gut, so now you have SIBO (small intestinal bacterial overgrowth), bacterial overgrowth, and now the gut can’t function. What innervates the gut? The vagus nerve, which is now not sending the feedback into the brain to say things are ok.”
Hence, a gut feeling that all is not well with a relationship can actually be a very big deal.
“In order to improve gut function, we need to get back to being empathetic. Taking time to “slow down”, to chew your food, to have an enjoyable conversation and not be rushed thru another meal only to get back to work, etc. You have to care enough about your partner to want to know what their needs are so you can address them, to talk with them and not “at” them, . But if you are going “But he/she hasn’t done this/that for me” then you are in a temporal (temporal lobe) frame of mind instead of frontal. We need to come back to “How can I help you?” instead of “Well, you haven’t helped me so I won’t help you?” This is the temporal/frontal dance of life that we go through.”
When we think about chronic illnesses that affect the gut, we are often looking at things like stress ulcers, acid reflux, leaky gut, irritable bowel, or other such conditions. We can fixate on the symptom, on the end organ discussion (and certainly these issues aren’t to be ignored), but there’s a wider picture to look at. Dr Hall says, “Part of nurturing the gut is loving one another, lifting and encouraging each other up, living a life where serving others is a priority in your life.” This brings us out of the temporal/occipital brain and into the frontal brain, which can dampen sympathetic hypervigilance and restore parasympathetic function.
But the chiropractic patient needn’t stop there when it comes to nurturing gut function. When we are thinking about this, Hall emphasises that we need to be talking not just about eliminating stress and making sure we have healthy relationships, but exercising, eating right, nurturing gut bacteria and digestive enzymes, and looking after vagal tone. How do we do the latter? There’s a lot to it, but the chiropractic adjustment can indeed stimulate it and allow the body to do the rest when the different elements just mentioned are working in harmony together.
“Have regular adjustments to remove subluxations. Have some fermented foods to help your stomach with acid, some enzymes if you need them. Now we can begin loving and caring, and nurturing the gut. Now I start to see you as a friend instead of a foe,” says Dr Hall by way of example.
He also offers up a warning: we can be starting our days or even our lives in stress and poor gut function. Even things we take for granted can matter. “If you wake up and think ‘I hate that alarm, and I already hate my day’ then you start the day off in poor gut function,” he says. Your reaction to the alarm and the dread of the day has sent a message that all is not well. Heart rate goes up. Stomach acid is affected. The vagus nerve that runs from gut to brain stops telling your brain all is well. Your amygdala detects a threat and kicks off a sympathetic response.
It’s a self-fulfilling prophecy. All of a sudden, all is not well.
But it can start off early in life, too, Hall explains.
“Babies born into stressful environments can be born in adrenal distress, and have difficulty breaking down proteins. Maybe now they have colic, can’t break down their food, bacteria and foreign proteins activate the immune system response [ left brain driven] which is on high alert and will start to attack everything. The right side brain, developmentally is concerned with posture, tone and the cervical curve as well as our love for one another and our sense that everything’s going to be alright, works to put the brakes on your immune system response. [As the child develops with alarm physiology and time passes we begin to see ] Food allergies and sensitivities, autoimmune conditions – it’s above down inside out. But that’s your embryology basic science. Raising a family takes a village. Stressed parents will often raise stressed children. We all need “a village”. We are connected and it is that interwoven relationship with others that strengthens our health – physical and emotional. That’s what we are missing in our health care plan – the connectedness with others. To know that we don’t have to carry the burden alone in our lives, that others want to help. There is strength in numbers. Under stress we tend to give up our time with friends and family, skip exercise, and don’t eat very well. We are sacrificing our health in order to make a dollar,” says Dr Hall.
It’s clear that we just can’t separate the gut brain from the central nervous system, but nurturing it isn’t just about eating the right foods and not eating the wrong stuff. It is much, much bigger than that. If we are concentrating on the end organ discussion, then we are stuck in a conversation that inevitably ends up with medications and surgery. But Hall argues that it’s about a functional neurology response, about understanding where this all begins, and knowing the basic science behind it. It goes back as far as understanding embryology, but involves even the simplest of tasks, which the modern world has complicated. ”Your mother said ‘chew your food’. That’s a vagal response. But we wolf it down to get back to our desks,” he says.
What can chiropractors do? We can help our patients be cognisant of all of this. Gut health isn’t just about eating or not eating. It’s about our whole system, our state of stress, our state of connectedness and all of this impacts the subluxation. “Do the burp test,” says Dr Hall. “If they fail it, give them enzymes to help with stomach acid. Adjust them. Remove their subluxations. Get them to talk, encourage them to go to a friends house for dinner [or encourage socialisations], improve vagal tone.” Facilitate hope in their lives. As Chiropractors we tend to be very “social” beings. Encourage and help others to use their “social” factor to improve their health.
The gut does not exist in its own little self-sealed system. It is stress-affected. It can cause stress. And all of this impacts vagal tone and subluxation. It’s a nice reminder that we need to look after whole system in order to support and attain not only gut health, but overall health.