Is It All In Your Head? Or All In Your Gut?

kali's picture

We’ve all heard (and many of us cringe at) the saying “it’s all in your head” – a dismissive way of telling someone that the very real emotional or physical disturbance they are feeling is made up.  The list of chronic diseases that have very little, if any, rational physiological basis is large, leading to an increasing percentage of the population with no medical explanation for their symptoms.  Irritable bowel syndrome (IBS), fibromyalgia and chronic fatigue syndrome are a few examples.  Medical terminology calls these conditions “functional” disorders; by definition, a functional disorder is one in which the symptoms are not explained by any anatomical, pathological or biochemical abnormality or by infection.  When a doctor says something is functional, it’s doc code for “all in her head.”  Which to some extent is correct – the patient’s experience is partly in their brain (where a great deal of perception happens) – but not in the dismissive sense that “all in her head” implies.


Perhaps a more accurate definition is that functional disorders are multi-factorial and not well understood nor measurable by modern science.  But forward thinking researchers are beginning to see that stress management plays a major role.


Dr. Gabor Mate, in his book “When The Body Says No: The Hidden Cost Of Stress”, shows by example how psychological trauma can manifest itself through physiological disorders.  In his chapter on IBS (irritable bowel syndrome), he explores how psychological trauma exerts its effect on the perception of pain, and makes some interesting observations about the effects of stress on the gut.


There is an entirely separate nervous system that is located in the gut called the “enteric nervous system”– it contains over one hundred million nerve cells.  In the small intestine alone, Dr. Mate says, we have as many nerve cells as in the entire spine!  Of note, these nerve cells aren’t just one-trick-ponies.  They do more than create peristalsis (slow contractions of the intestines) and facilitate absorption of nutrients.  These nerve cells respond to emotional stimuli.  Studies have shown that certain emotional responses cause spasm in the intestinal smooth muscles, redirection of blood flow toward or away from digestive processes, and secretion of many different biologically active substances like hormones and neurotransmitters.  These physiological responses to psychological emotional states are crucial to survival – if you’re relaxing under a tree and a bear starts charging after you, you’d rely on your enteric nervous system to redirect large volumes of blood from your digestive system to your heart and large muscle groups so you could run away ASAP.  So information travels easily, and quickly, from the brain to the gut.


Perhaps even more intriguing about the gut-brain connection is the fact that the gut is also greatly supplied with sensory nerves that carry information from the gut to the brain.  The communication goes both ways.  It’s been recently shown that these nerve cells that move information upward greatly outnumber those that descend from the brain to the gut.  How it works?  The brain sends down its emotional interpretation of what’s going on in a given situation; it takes info from the sensory organs (eyes, ears, nose), interprets them emotionally, and instigates a physiological effect in the gut.  A resulting physical reaction reinforces the emotional interpretation, and that sensation is sent upward for interpretation by the brain (experienced by you as a “gut reaction”).  When there have been too many “gut wrenching” experiences – like trauma or abuse – or when someone with a particularly sensitive constitution processes daily dramatics as traumatic events – this neurological apparatus can become over-sensitized.  Then the patient begins experiencing normal physiological processes as painful ones.  In the case of an IBS patient, they experience normal amounts of gas or tension in the intestinal tract as extremely painful cramping.  Or small amounts of stress cause intestinal spasms that result in either constipation or diarrhea – a hallmark of the condition is to oscillate between the two.


Along with the physical symptoms, scientists have shown that the brains of people with functional disorders (IBS in this case) show brain activity patterns consistent with being on hyper-alert.  They respond with distress to normal physiological processes.  Not surprising, then, that many patients with functional disorders like IBS experience higher levels of anxiety and fatigue than those without the disorder.


This gut-brain pathway becomes over-sensitized for many reasons, and can cause a vast array of symptom pictures.  Considering that 80% of the body’s serotonin is produced in the gut, and over 70% of the immune system is located there, virtually all mental, emotional, and physical symptoms have some origin here.  Which means (I know, I know) that stress is playing a role in most modern diseases.


Dr. Mate’s book is a wonderful look into the emotional root of chronic disease.  He says “gut feelings are an important part of the body’s sensory apparatus… [they] magnify perceptions that the emotional centers of the brain find important and relay through the hypothalamus.  Pain in the gut is one signal the body uses to send messages that are difficult for us to ignore.”  The idea is that, in our constant effort to ignore, or repress, stressful situations or avoid dealing with emotional turmoil, we often cause over-sensitivity of the gut-brain pathways.  Eventually, the body responds with physical symptoms, saying ‘you want to ignore the emotional symptoms? Ok, here are some physical signals for you.’  The solution – to spend time addressing the emotional turmoil and put systems in place to better manage stress – is easier said than done.  But it is absolutely necessary to both prevent and treat chronic disease.


Speak to your Acubalance practitioner about stress management.  We’re here to listen and guide you to a more balanced approach to your life.


In health,

Dr. Kali MacIsaac HBSc, ND
Naturopathic Doctor

When The Body Says No, Dr. Gabor Mate