FGID’s – Part 3

The phrase “butterflies in my stomach” refers to a common experience – that fluttery feeling in the stomach before a stressful event, a big presentation, a first date and even moments before riding on a rollercoaster or boarding a plane. It is an idiomatic expression that means that a person is anxious or has a nervous feeling in their stomach.

Although, patients with functional gastrointestinal disorders (FGID’s) will tend to focus on the possible physical causes of their symptoms (at the gut level), the relationship between psychological stress and the onset or exacerbation of symptoms should always be taken into consideration.

When an individual is stressed they will often be in a sympathetic state (fight or flight) which will do a number of things. It will:

– Inhibit gut transit and secretion

– Stimulate contractile activity of the sphincters

– Induce vasoconstriction and even modulate the mucosal immune system and microbiota

– Increase painful perceptions arising from gastrointestinal stimuli (referred to as visceral hypersensitivity), and

– Compromise the vago-vagal reflex

The vago-vagal reflex, which stimulates the secretion of a number of hormones, will be impaired and impact:

– Gastrin: which promotes the secretion of gastric acid and allows the stomach to break down food, enhance the absorption of nutrients and aid digestion.

– Somatostatin: which plays a physiological role in regulating gastric acid secretion, and is also thought to modulate the intestinal absorption rate and inhibit intestinal motility.

– Serotonin: which has a role in mood modulation. Given that 90% of it is made in the gut, it is no surprise that less than ideal levels of serotonin are linked to higher levels of depression and anxiety.

– Innate and acquired immunity.

The key message here is that although many of us will continue to experience “butterflies”, research suggests that working on ways to bring the body back into the parasympathetic state, and back into a state of calm, will aid digestion.

For many this may feel impossible and take time.

Sometimes, we have to sit in the uncomfortable and messy space for a short while, or as a Brene Brown puts it, lean in.

At other times, we may need some extra support and guidance from a close friend or family member, a counselor, a psychologist or psychotherapist.

I often encourage my patients to take small steps. To do what they can, and to continue to be gentle with the person that they are generally most impatient with, themselves.

Wishing you wellness,

Mary Clark