The practice of mindfulness is helping people to live more intentionally and in the present moment, and has become embedded in to our everyday language these days. What you may not realise is that mindfulness may also be a useful tool in supporting gut-related disorders such as constipation. It was World Mental Health Day this week, which highlighted that stress is an issue for many of us on a daily basis, and how difficult it can be to maintain a healthy work/life balance. Mental health is a big social challenge of our time and, according to the Mental Heath Foundation, by 2030 depression may be the leading cause of disease globally. Mindfulness practices have been associated with a multitude of health benefits, and are being talked about more and more these days as we all seek to find more balance within our stressful lifestyles. But what exactly is mindfulness and how can it help with digestive issues such as constipation?
What is mindfulness?
Mindfulness is the act of being aware and fully present, and using this awareness as a way of controlling stress and emotions. The use of mindfulness as a therapeutic tool began in the late 1970s with the development of the Mindfulness-Based Stress Reduction (MBSR) program as a treatment for chronic pain. The MBSR program has been combined with CBT in the development of Mindfulness-Based Cognitive Therapy (MBCT) and was developed for the prevention of depression. There is continuing evidence to support its use in pain, mood, and gastrointestinal related disorders.1
Mindfulness takes on a multi-component approach and includes activities such as meditation, group discussion, retreats, and daily home practice. Interventions have now extended to include activities such as:
> Yoga - using breath and movement to reduce stress.
> Daily mindfulness meditations - sitting/walking meditations.
> Body scan meditation - tuning in to body sensations and stress.
> Mindful eating practices - eat intentionally without distractions.
> Forest therapy healing - promote calm and connect with nature.
Mindfulness practices look at bringing in present moment awareness, attention, non-judgement, insight, compassion, rest, and self-care into our daily lives.
How can mindfulness help reduce stress and support gut health?
The development of constipation is multifactorial in that it has been linked with genetic predisposition, low fibre diet, dysbiosis, lack of fluid intake, side effects of medications, lack of exercise, chronic stress, and hormone imbalance. Mindfulness addresses the psychosocial practices (cognitive and emotional) that could be contributing to your constipation. Mindfulness training has been shown to have a therapeutic effect on IBS related symptoms which includes constipation by reducing stress. Psychological factors can certainly influence gut activity and contribute to or exacerbate bowel symptoms such as constipation. In a study published in the journal Gastroenterology and Hepatology, mindfulness-based therapy demonstrated long-term efficacy among patients suffering from Irritable Bowel Syndrome.2
In this study, the mindfulness-based multi-component approach appeared to decrease symptoms of IBS through the mental skills of mindfulness, which include awareness of the breathing process, conscious eating, and other daily practices. Many cognitive disorders such as anxiety, depression, ADHD, and bipolar disorder also present with GI symptoms such as changes in bowel movements, dysbiosis, gastro oesophageal reflux disease (GERD), and leaky gut.
The effects of mindfulness practices on gut bacteria have been poorly studied in comparison to probiotic, prebiotic, and antibiotic interventions, however, new research looking at the gut-brain axis, is shedding light on the connection between our gut and our mind. The gut and the brain communicate with each other through the vagus nerve, via the enteric nervous system. A particular interest in the gut brain axis was sparked after a study by Sudo and colleagues in 2004, which found that germ-free mice had an impaired stress response, causing an exaggerated HPA-axis (hypothalamic-piuitary-adrenal-axis - our central stress response sytem) reaction to stressful stimuli. After colonisation with a Bifidobacteria species they were able to normalise the stress response. In other studies looking at the effects of stress on the gut, preliminary research shows that the microbiota is a key facilitator of stress adaptation and that they bi-directionly communicate and influence one another.
A key neurotransmitter involved in healthy bowel movements is serotonin, the 'feel-good' neurotransmitter that acts as an important signalling molecule required for optimum gut motility.3 90% of serotonin is produced in our guts and 10% in our brain, and it helps to propel food along the GI tract. A deficiency in serotonin can be brought on by unmanaged prolonged stress, as well as poor blood sugar control, and nutrient deficiencies. Managing these factors is crucial for keeping serotonin levels healthy and supporting gut health. A study looking at the effect of transcendental meditation on neurotransmitter levels on behaviour and anxiety found that serotonin levels were much higher after meditating. Sustained, ongoing, chronic stress raises cortisol and reduces serotonin availability, resulting in gut dysfunction. You can read more about how our emotional landscape influences constipation here.
A key component of good digestive health is maintaining a healthy microbiome - the food we eat has arguably the biggest impact on our gut microbiome. However, it is also clear that our lifestyle, including psychological stress, physical activity, environmental exposures, toxins, and contact with nature, all significantly impact our gut health. Preliminary studies, in the role that gut bacteria plays in stress and anxiety, have shown that the microbiota is a key facilitator of stress adaptation and the stress response. Due to this bi-directional link between the gut and the brain, it seems correct to assume that any mindfulness practice that supports the nervous system stress response will ultimately have a positive affect on gut health.
Yoga for constipation
Yoga is an excellent way to become more mindful and tune in to your body and mind. It increases the flow of blood and oxygen in the body and a daily practice can support infrequent bowel movements and bloating.
Here are some yoga postures (asanas) which can help to support regular bowel movements.
1. Standing Forward Bend
How to do it: Stand with feet hips-width distance apart. Hinge at the hips to fold forward, drawing the chest toward the thighs, bending your knees if necessary. Stack the hips over the ankles and let the back of the neck relax. Drop your arms towards the floor, or grab opposite biceps to draw deeper into the pose. Press into the soles of the feet without gripping the toes, and firm up the legs. Take 10 deep breaths.
Why it works: This pose calms the nervous system and causes compression in the abdomen area, which will aid digestion.
2. Seated Twist
How to do it: Begin seated with legs straight out in front of you. Bend the right knee and cross your right leg over your left, placing the right foot outside of the left knee. Keep the left leg long. Wrap the left arm around the right leg, placing the right hand on the ground behind the sacrum (low back). Lengthen on the inhale, and deepen the twist to your right on the exhale. Take 10 breaths, then repeat on the other side.
Why it works: The twisting massages the digestive tract to stimulate detoxification. The physiological aspects of this asana (posture) are that it stimulates the pancreas, liver, spleen, kidneys, stomach, and ascending and descending colons; hence improving bowel movements and providing relief from constipation.
3. Knee to Chest Pose
How to do it: Lie on your back with both legs extended straight. Draw the right knee into the chest with both arms. Hold for 20 breaths. Return to the start position and then reach the right arm overhead to stretch the length of the right side of the body. Hold for 10 breaths, then repeat on the other side.
Why it works: This is the pose for bloated bellies, as it helps eliminate gas—as the name of the pose so boldly claims. It stimulates the ascending, descending, and transverse colon, as well as the stomach and small intestines. The order in which it is performed—right side, then left—can help stimulate the bowels and ease constipation.
Meditation for constipation
Mindfulness meditation is a unique psychological approach that supports mind body interactions. A daily meditation practice is a great way to calm the mind and activate the sympathetic nervous system of rest and digest. A regular practice can make you calmer and more focused, improve deep sleep, and literally power you up so that you may need less sleep overall.
Meditation calms the nervous system, boosting serotonin and lowering cortisol. Having recently completed a course in Transcendental Meditation (TM), I can highly recommend the benefits of practicing 20 mins of meditation twice a day. TM uses a silent mantra that works on a vibrational level and allows the 'monkey mind' to focus and not drift between thoughts. If you're not ready to delve in to a TM course just yet, there are some great apps on the market such as Insight Timer, which has guided meditations to get you started. Here is a guided meditation that supports gut motility:
Mindful eating for constipation - do you pay attention when you eat?
Mindful eating is another way to cultivate present moment awareness. As a nutritional therapist, I recommend mindful eating regularly to my clients who often forget to take the time to anticipate what they are about to eat and have forgotten how to eat intuitively, without distractions such as phones, iPads, Netflix, etc. There is lots of reasearch out there on the benefits of a mindful eating practice in relation to obesity, mood and inflammatory markers.
Conscious eating is a tool you can use to address your eating habits. It’s about tuning in and paying attention to the look, smell, taste, and feel of your food. Can you remember everything you ate today? My clients often struggle to complete a 3-day food diary and aren’t fully acknowledging the benefits of eating a healthy diet. Everything you put in to your mouth has a direct effect on your gut bacteria, your immune system, and your overall health. Every time you choose a food, take a moment to think whether it is going to positively or negatively affect your body. High consumption of processed packaged foods, refined sugars, gluten and alcohol, coupled with a low fibre intake, will have a negative impact on your gut health.
Simple steps you can take include creating more awareness around what you are eating, eating with reverence, eating slowly, blessing your food, chewing more, and not eating when you are anxious or stressed. I also get my clients to take 3 big belly breaths before eating a meal to activate their parasympathetic nervous system and aid digestion.
You may also be interested in reading the following articles:
Research and consolidation by Katie Wheaton, DIP NT, mBANT, CNHC, mANP
1 Aucoin, M et al, (2014) Mindfulness-Based Therapies in the Treatment of Functional Gastrointestinal Disorders: A Meta-Analysis, 'Evidence based Complementary and Alternative Medicine', [online] 140724. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177184/ Accessed: 6/10/2018
2 Zomorodi, S et al (2014) Comparison of long-term effects of cognitive-behavioral therapy versus mindfulness-based therapy on reduction of symptoms among patients suffering from irritable bowel syndrome, 'Gastroenterology and Hepatology from Bed to Bench', [online] Volume 7(2), pp. 118–124 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017567/#CIT0018 Accessed: 6/10/18
3Made G M, Hoffman J M, (Aug 2013) ‘Serotonin Signalling in the Gastrointestinal Tract, 'Nat Rev Gastroenterol Hepatol', [online] vol 10(8), pp. 473-486 Available at: https://www.nature.com/articles/nrgastro.2013.105 Accessed: 6/10/18