April/May 2022 Issue

Mindfulness: Mind-Body Modalities and GI Disorders
By Diane Welland, MS, RD
Today’s Dietitian
Vol. 24, No. 4, P. 22

Are they more efficacious than pharmacotherapy in treatment and management?

According to a worldwide survey of 33 countries, including the United States, functional gastrointestinal (GI) disorders affect more than 40% of adults worldwide and have a major impact on the economy, health care system, and quality of life.1 Estimations vary, but 25 million to 82 million Americans are thought to have at least one functional GI disorder.2

Of those disorders, one of the most common is irritable bowel syndrome (IBS). This isn’t to be confused with inflammatory bowel disease (IBD), which produces similar symptoms—gas, bloating, abdominal pain, and diarrhea—but is caused by inflammation, while IBS is caused by a dysfunction of the GI tract in the absence of inflammation or other apparent changes to the GI tract. While it’s possible to have both IBS and IBD, scientists are still trying to understand more about these illnesses. Both disorders, however, are chronic conditions and known to be exacerbated by stress and psychosocial factors.3

Consequently, many people suffering from IBS and IBD often report depression, anxiety, and poor quality of life. While diet therapy is one critical component in managing symptoms, new and emerging research shows that incorporating mind-body interventions, such as yoga, mindful meditation, and relaxation techniques, as part of the management plan can significantly reduce stress and have a beneficial impact on the GI tract.3-5 Yoga in particular includes a combination of both physical and mental elements that, in some cases, can be more effective than traditional medical treatments or cognitive therapies alone in IBS and IBD. Studies show yoga can help lessen GI symptoms, decrease anxiety, and boost feelings of general well-being.4

In addition, research suggests mind-body modalities may positively impact the microbiome by improving digestion and immune function and decreasing levels of inflammation.6

IBS and IBD — Searching for Relief
IBS is one of the most commonly diagnosed digestive disorders in the United States, affecting 25 million to 45 million people, two-thirds of them women. Symptoms also often interfere with daily life and work productivity. It’s a multifactorial, complex condition with a spectrum of GI problems—the cause of which isn’t clearly understood. Lack of effective treatments has led many people to search for alternative therapies.7 In fact, up to 50% of individuals with IBS seek nonpharmacological treatments to manage symptoms.4

As in IBS, psychosocial stressors causing anxiety, depression, negative moods, and poor quality of life exacerbate IBD. The two most common IBD disorders are Crohn’s disease and ulcerative colitis. In both cases, stress not only affects the severity of the illness but also triggers flare-ups, increasing frequency.8 It’s estimated that more than 1.5 million people in the United States live with IBD, and incidence is rising, particularly in developed countries. While the exact cause of IBD remains unknown, the pathology is likely related to a combination of factors including genetics, drugs such as antibiotics and nonsteroidal anti-inflammatory drugs, a Western diet, immune dysfunction, and an altered gut microbiome.9-11

Mind-body interventions are particularly promising because they directly impact the gut-brain axis, the bidirectional communication between the digestive tract and the brain. This system links the nervous system with the digestive system through a complex network of neuroendocrine immune signaling pathways and the hypothalamus-pituitary-adrenal axis, meaning there’s a direct connection between mental health and GI health.12 Not surprisingly, many mind-body relaxation/stress management techniques have been shown as effective treatments for GI symptoms by reducing stress and anxiety and increasing overall feelings of well-being.13,14

IBS and IBD patients widely accept these techniques because they’re easy to do, are inexpensive, and can be done at home. The techniques also are generally perceived as beneficial and safe.4

Why Yoga?
Yoga is a mind-body-breath discipline that strives to create harmony between body and mind, develop awareness, promote relaxation, and improve well-being. It’s an ancient practice that some say dates back 3,500 years in India. The term “yoga” is derived from the Sanskrit word yuj, meaning to unite body, mind, and spirit.13 Although there are many different types of yoga, all yoga includes mindfulness/meditation, physical movement, and structured breathing to some extent.

Over the last few decades, yoga has become increasingly popular in Western culture, and not just as a recreational or lifestyle practice. Emerging science focuses on yoga in the health care setting as a way to complement Western medicine and treat illness.15 Because yoga targets multiple areas of health, preliminary data show that it may be a safe and effective treatment for IBS. And a review of several small randomized controlled trials found yoga might be more effective than some pharmacological treatments.4

Evidence shows movement plays a role in improving and managing gut health. Although little research has been done on yoga poses, several are thought to aid in digestion. Furthermore, many yoga classes emphasize increasing strength, flexibility, stretching, and range of motion, which promote overall health.4

“In yoga, you are matching the breath to the movement and cultivating an attitude of mindfulness. Mindfulness creates awareness and has a healing element,” says Anu Kaur, MS, RDN, RYT-500, mind-body therapy chair for Dietitians in Integrative and Functional Medicine, a dietetic practice group of the Academy of Nutrition and Dietetics, and founder of A Nu Healthy You, a nutrition business that offers individual nutrition counseling and various wellness services. Kaur has been practicing yoga and incorporating it into her practice for more than 10 years. “Mindfulness is a process and a gentle way to invite (positive) change through relaxation, posture, and connection to the breath,” she says.

Indeed, more and more research on stress reduction techniques related to posture, breathing, and relaxation are showing that mind-body modalities such as yoga reduce stress, decreasing the incidence and severity of IBS symptoms.4,14 Similar benefits have been found in studies in adult and pediatric IBD patients, and studies show mindfulness-based stress reduction techniques, including yoga, can decrease pain and anxiety levels in people with IBD.3,13,16

One study looking at children aged 8 to 18 with abdominal pain due to functional GI disorders compared the effects of yoga therapy with those of a control (standard medical care). At a 12-month follow-up, researchers found the children in the yoga group had significantly improved abdominal pain and reduced school absence compared with controls.17

Mind-body modalities such as yoga also have been compared with diet therapy. One 12-week intervention study looked at IBS symptoms in patients receiving either three nutrition counseling sessions on a low-FODMAP diet or twice-weekly yoga sessions. The groups were assessed at 12 and 24 weeks. While both interventions were found to be equally effective at reducing GI symptoms, the yoga group reported greater improvements in perceived body awareness, mind-body connection, and anxiety.18

Pamela Malo, MHS, RD, KYT, a private practice dietitian and yoga instructor in Bainbridge Island, Washington, isn’t surprised by these results. She has been using mind-body techniques in her practice for more than a decade. “Stress is often an underlying factor for individuals with GI issues,” Malo says. “So often at the start of a session, I will ask my clients if they want to take a few deep breaths together. This simple mind-body practice can help them be more present and relaxed—and change is always easier from a state of relaxation.”

Stress and GI Problems
Stress activates the sympathetic nervous system as part of the “fight or flight" response, which quickly mobilizes metabolic resources and effectively inhibits GI function. On the other hand, the parasympathetic nervous system works in the opposite direction, counteracting the stress-inducing effects and hyperactivity of the sympathetic nervous system and returning blood flow and activity to the GI tract.12 The parasympathetic nervous system elicits a “rest and digest” response, optimizing digestion.

After acute stress, the body is designed to return to this “rest and digest” state via the parasympathetic nervous system, but chronic stress can upset this balance, impair metabolic return, and lead to GI issues. Many people with IBS have increased sympathetic nervous system activity.4,12

“The relaxation response techniques used in mind-body modalities like yoga and meditation activate the parasympathetic nervous system and allow the body to ‘rest and digest,’” Kaur says.

Yoga also can increase stimulation of the vagus nerve, an essential nerve in the parasympathetic system that travels from the brain to the intestines and regulates the gut-brain axis. It also oversees several functions, including immune response, digestion, and heart rate. Its increased activity may help reduce inflammation.9

“Low vagal tone is observed in digestive disorders and IBD,” Malo says. “Practicing yoga has been shown to activate the vagus nerve and increase vagal tone.”4,9,19

Other studies have linked mind-body relaxation techniques, including yoga, to an improved gut microbiome, better immune response, and gene expression.3,6 But while research on the health benefits of yoga is increasing, more studies are needed.

Recommendations for Dietitians
It’s important for RDs to be aware that stress influences not only mental health but also digestive health and diet. Chronically high stress levels can increase IBS and IBD symptoms, lead to poor dietary choices, and disrupt dietary patterns, causing people to overeat or skip meals. High stress also can lead to anxiety, depression, negative emotions, and decreased quality of life.

By focusing on breath, movement, and relaxation techniques, yoga has been shown to improve GI symptoms, reduce and manage stress, and promote positive feelings of health and well-being. Using mindfulness techniques and mind-body strategies such as yoga to help clients better cope with the worries of everyday life may make it easier for them to accept dietary advice, make positive dietary changes, and improve their health. Yoga also is relatively safe and can be adapted for individuals of all fitness levels and abilities. For these reasons, dietitians may want to take a more holistic approach to nutrition and health when counseling patients and recommend incorporating mind-body modalities such as yoga into their treatment plan.

To learn more on how to do this and perhaps pursue certification in integrative nutrition, visit the Dietitians in Integrative and Functional Medicine Dietetic Practice Group at integrativerd.org.

— Diane Welland, MS, RD, is a public relations professional, speaker, award-winning recipe developer, and author. She’s the director of nutrition communications at Kellen, an association management firm in Washington, D.C., where she specializes in tracking trends and translating nutrition science into layman’s terms.

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