Gut-brain axis, a different look
We are going to talk about the double relationship and influences between the intestine and the brain , and why it is important to know this double pathway and its relationships, because they are linked to functional health to physical health to Mental Health.
It is based on understanding the relationships of the autonomic nervous system with this brain-intestinal axis, which is fundamental for the maintenance of our integral health, which is the Gear Grant axis, welcome!
We are going to talk in this class about topics related to the gut-brain axis but not from the tissue, nor from the technique, but we are going to give a totally different meaning to a basic therapeutic approach, we are going to talk from the reasoning and, from the mechanisms.
There is more for therapies but the construction of this class that we can identify all the possible elements that are generating changes, be it in our physical health or in our gastrointestinal health or in our mental health, the construction of this class
It is made so that you realize the number of elements that must be evaluated before deciding if it is better to take a probiotic, a prebiotic or a synbiotic, or change the diet, or do exercises, or it could be to do mind-body therapy a cognitive behavioral therapy there are a lot of elements that is outrageous for this.
This class is drawn so that you can understand a little better what is the circuit that is involved in this ,in this network, in this case , or in these
functional health situations, and that by understanding this you can be a little more critical, or with what you prescribe as a therapeutic tool, or with what you buy as a patient of a therapist.
Ok so the first part of all this is to build a more critical perspective of everything that I know offers
With this part of the construction of the reasoning based on the gut-brain axis and because the vagus nerve is one of the keys to all this, I will talk about a real clinical case of one of a patient of mine after, but now, I will describe all the relationships of functional systems.
What are functional system relationships?
All the systems of our body that are related in some way to the brain or that suffer direct or indirect influences of good or bad regulation of the gut-brain axis.
There I am going to bring you a clinical case with all the assessment of the gastrointestinal system with all the assessment of the craniocervical system of the thoracic and abdominal system , all the assessment of the autonomic system ,so, that we can understand why the gastrointestinal dysfunctions of this patient that I am going to present to you are influencing bruxism.
What we are going to do is take all this knowledge, this most critical part, that we are going to develop and apply in a more direct way, so that you can have a slightly larger perspective a little broader, so that you can really broaden your gaze, so that you can
build a new perspective for your patients/clients and we are going to do this work with the diagnoses of dysfunctions vagus linked to the Gut-brain axis using the vagus as part of the autonomic nervous system as a tool of diagnosis to understand the different influences of the autonomic system on the gastrointestinal system, on the emotional system, on the cognitive system of our patients.
In the end, by integrating everything, we are more capable of reaching more timely, more effective, more efficient solutions, but the first thing is to conclude where the problem, Why the therapy proposed by our client’s doctor, physical therapist, or osteopath is not working.
We start talking about axes
It is important because when we talk about axes we are always talking about something that communicates
two elements, two systems or something that coordinates the systems or something that works as a pivot for two elements in this case when we are
speaking of the gut-brain axis, we are talking about an axis that connects the gastrointestinal system. The gastrointestinal system is not only the intestine
i.e. esophagus, stomach, duodenum large intestine
all of this connected to the central nervous system, So whenever, we’re talking about axes, we’re talking about axis, we have to know this
axis connects ,what connects,what that takes me from point A to point B Ok but:
What is point A what is point B ?
When we talk about the HPA axis, for example, we are talking about the hypothalamus, pituitary, adrenal axis, that is, it is a communication circuit that goes to connecting the hypothalamus with the pituitary with the adrenals is a communication circuit and when we talk about communication we are talking about something that is super important not only for our physical health but also for our mental health.
Well Miguel, what do you mean?
This is decisive so that I can communicate with you so that I can transmit the message to you so that you can ask me what you want, so, that you can transmit your message to me ,and it also works in this way in our physiological plan, in our homeostatic plan ,in our physical plan, in our plan
biological, I mean, that our body communicates to other different structures of our body (for example hormones, through the blood…)
When we say gut-brain connection, it is not enough to say I have a dysfunction of the gut-brain axis it is not enough to say .
I have a get Brain axis dysfunction because there are thousands of elements that can be dysfunctional between these two structures and we are going to see this in this class.
When we speak, it is important to speak not only about the path that all this is going to lead, but it is important to speak also what message is being transmitted through this channel, what messages are being transmitted through this channel and what quality of information. For example, we eventually talk about serotonin problems for people who suffer from insomnia, for example, with sleep disturbances, we talk about serotonin AND then the doctor can ask the patient to take, supplement with melatonin, because they are in the metabolic route of serotonin and, this facilitates the issue and then comes the scientific articles of experts agreeing because most of the serotonin in the body is being produced by the gastrointestinal system, well perfect we totally agree, but the question to you is:
who is also carrying this message that there is production of serotonin in the gastrointestinal system?
who will take this message to the central system?
This is the yes OK now my question to you is the part that we usually don’t realize.
We know where Is serotonin being produced? Yes? OK, now, my question to you is the part that we usually don’t realize.
Is the physiological pathway that should conduct this information preserved and capable of generating this information? yes or no ? This is the issue and the same thing happens when we talk about ghrelin, when we talk about cholecystocnin when we talk about leptin, it happens the same for..
what happens ? because some structure has to perceive this stimulus someone has to conduct this stimulus from point A to point B.
Ok, so what messages are you conveying in the case of a client with insomniac? And who is the messenger? These are important things for us.
Well, when we talk about communication, it is important to talk about the route.
cadian rhythms, or is it a neural pathway, or is it a humoral pathway that we are using to transmit this information
- What is the route? What do you mean by the route?
- What is the route that this route has in our body?
- Where does it go?
- By what points of entrapment or points of conflict?What is the route we are using?
- is it a cellular pathway that we are using?
- What is the route that follows?
- is it a spinal pathway?
- Is it a previous route of the trunk?
- is it a vascular route?
- What is the path followed by the transmission speed of this impulse?
- Delay much to carry that information?
- Does it take a short time to carry this information?
- It is the transmission speed of the impulse and obviously from which point to which point of
which point B of the system is connecting me then that
it is important to keep in mind when we are talking about communication then we are going to have the messages Well what kind of messages are you sending?
- The message type is a chemical message?
- is it an electrical message?
- What kind of message are we sending through this route
important to know which receiver I’m working on?
- What kind of receivers am I eventually working with?
We do not forget the receiver
I’ve seen many many teachers of mine saying you have to work this area of the neck, this area here on the side of the neck. Here is the sternocleidomastoid to be able to activate the vagus nerve and this has always seemed strange to me because the vagus passes through this area
Yes but here The vagus nerve does not have a somatic receptor field. What does this mean? That in this area the vagus nerve does not capture this touch information from touch, this information doesn’t get it.
So it can’t be a vagus nerve, it could be something indirect that I’m doing, but vagal as it cannot be, because the vagal receptor that we have here is not a receptor that is in the skin, so knowing the type of receptor that we are working on, is important and what is the type of transmission being made.
- is it an electric transmission?
- is it a chemical transmission?
- What is the type of transmission that this message is generating?
- Ok and then we will have the messenger itself
- Who is the messenger?
- Is a a vagal afferent?
- is an afferent with visceral sensitivity?
- Is it a splanchnic afferent?
- For example, or somatic sensitivity?
- Or is it carrying temperature information and how does the information move in this messenger?
- How does this information move, for example, if I am talking about an arterial circuit?
- how they move which direction they
- there are valves there are no valves?
- There is a possibility of reflux or there is no
possibility of reflux?
- I am calm with what I am doing because from this point nothing Come back? or not ?
- I’m not calm because from this point everything can go back to its previous moment?
So this is important to consider because this is going to give us success or failure in the treatment.
When we are talking about structure, the points that we are connecting will just be the points between the system gastrointestinal and central nervous system.
we are going to the transformation very well then when we talk about microbiota and I already know that there are a lot of fans of microbiota, I am one of them also the only thing is that I do not allow myself to reduce my gaze to the microbiota when we talk about microbiota
when we talk about intestins we are talking about the whole part that is down here ,so pay attention when I say look, maybe it is a prebiotic for you or the best we change the diet? Do we do ketogenic diet? are we going to do a mediterranean diet? Are we going to have an intermittent diet? or well we are going to do physical exercises to see if it improves your constipation, we are going to do an abdominal massage visceral, osteopathy?
We will talk about the brain but we are going to start with the Gut.
So when we are saying this When a patient goes to a grocery store supplements and asks someone who is there a supplement a probiotic for example. What functions am I assuming? for example that the Barrier function is preserved? yes or no? I am assuming that the gastrointestinal barrier is preserved that there is no hyperpermeability of the gastrointestinal barrier and why this is because there is hyperpermeability of the
gastrointestinal barrier, the probiotic is not going to work. Because if there is an intestinal hyperpermeability I need to first look for other elements that they offer me
the possibility of achieving better results through this resource. for example if I have a sympathetic hyperactivity, a sympathetic system fired all the time and a low vagal tone ,it is possible that all this diet and the change of eating behavior, that using supplements, does not work well.
why? Because the autonomic system innervates the gastrointestinal system and you will understand why this happens, the same way, for example, I ask a client of mine to work with cognitive behavioral therapy, or any other type of cognitive therapy, I ask the client to change his habits, change his sleeping habits, change his routine, I no longer want you to look anxious, we are going to try to fix this and then you ask him for a series of exercises, daily life adaptations, adaptations, so you can better control anxiety. ok perfect! but what happens is that you haven’t realized that,, but but that if This patient for example may have a dysbiosis
important intestinal?? and when having an important dysbiosis ?What happens is that the production of cytokines pro-inflammatory cytokines in your body is high ,and when there is a lot of Chronic production of inflammatory cytokines in the body some people start to
behaving sick? when they are not really sick, this is called true signs AND if it occurs due to the increase in pro-inflammatory cytokines in the blood. and what happens? I begin to show changes in the behavior of the behavior, memory, cognition, when really the problem is not there but I am using it
a tool to correct whats happen up, here inthe brain, but the problem that is altering my entire system is down, in the intestine, in the enteric brain…
And why are there times when it doesn’t resolve itself? because the gastrointestinal system, the microbiota, the gut is isolated from other body systems and relies heavily on them for good regulation
so when we talk about guts, of microbiota we cannot assume that this system is capable of fixing itself,
we also have to count on others support systems, with the other information communication systems that are linked to the gastrointestinal system. when we deal with this we are assuming that this system is going to generate information and this information is going to rise and this information that is being generated here in the intestine it will reach the brain.
Have you noticed when we talk about the gut-brain axis we are assuming that everything I am working on down here will come up there? yes or no? It’s a matter of time!! Yes or yes?
Say it loud because it’s important
“I am assuming that everything that is being produced in the intestine will reach the brain” and upon arrival
top :What do you have to produce? because it has to produce changes, it has to produce alterations, it has that produce functional modifications if we are talking about therapy, functional modifications I am not going to assume that what I am prescribing (exercise, change of diet, change of life, quality of sleep) is not going to harm the patient because I invested enough time working in his problem to be able to give the best solution to the patient, so what I am offering as therapy here, I am thinking that it will reach up here,
Let’s review: this information, the way, the route, The messenger, the message, the way, the route, the message of the message, do you remember point A to point B !!okay so, I assume this it will arrive up here and when it arrives up here (to the brain) I assume that it will produce a series of functional adaptations and producing the functional adaptations, the central system will return one or another response to me, it will return other information, and this other information to.
who is headed? also to the gastrointestinal system, not only but also to the gastrointestinal system and we call this as “an axis that is bidirectional” because goes in both directions, it goes from bottom to top, and when it goes from bottom to top .Let’s call this bottom-up bottom-up, and then it goes top-down and we’re going to call this top-down. I ask you to warm up the engines the structures that I have here in this information channel the structures that carry this information up will they be the same structures that will carry this information down? yes or no? What do you think? No! Aren’t they the same? if they are not the same structures it is important to know who goes up with the information just as it is important to know who goes down with the information why.
Why Miguel I have to know this?
Because we may have a problem down here, Ok,we may have a problem on the road who communicates this information, or we may have a problem in who receives this information, we may have a problem in who provides the response or, we may have a problem in who receives the response; We can have multiple altered points on this axis and Seeking to solve one point without considering the others is a failure of reasoning.
Why is it important to know this ? This is involved Mental Health So gut-brain axis problems are linked to conditions such as anxiety, conditions such as depression, conditions such as mood disorders, chronic stress, to the state of mind, the alterations dysfunctions of the axis gut-brain are associated with all these conditions ,that we have here and there are more
but this is not a treaty of conditions, because if we were not going to get here we would only do a check of all the conditions that are linked to this, but look how interesting. anxiety, depression and chronic stress in general when we listen this, we link our mind immediately, links everything to the alteration that is generating between the intestine and brain.
we usually think that the answer is in the brain, for example a psychologist or a psychiatrist would think so, but it may happen that the problem that is up here really begins and is directly related to the brain.
When we talk about the gastrointestinal system we are talking about inflammation, do you know a patient, someone, a colleague, friend who suffers from inflammation? Who eats something starts with autonomic symptoms!! What starts to sweat? Start to scratch a lot? does it start to itch? Or maybe it starts with nausea? Or maybe with vomiting? or with reflux or swelling of the gut? Or maybe he produces a lot of gas? Or then after eating something he starts with visceral pain.
An example of classic visceral pain when you have sensitivity or intolerance to some type of food group but coming out of the gastrointestinal system an example of a more classic visceral pain for those who don’t know
going a little bit to the pelvic system is premenstrual pain, this is a pain that is also associated with microbiota alterations, constipation, diarrhea, thickened digestion, gastroesophageal reflux…
If I had to tell you about all this, it’s here. Who is the star symptom?
Is gas reflux is the most common disorder that we see of disorders of the axis, intestine-brain and I could guarantee that it is associated with at least 70% of all these conditions that we are talking about here
but well. Let’s continue. So this is what we have when we talk more or less about what comes to mind. Look how interesting that one of the best therapies today for irritable bowel problems, for example, is hypnosis. It is cognitive behavioral therapy. It is one of the best colon therapies, irritable bowel, to control stress related to irritable colon and when we have a patient suffering from irritable bowel, it may not come to mind that the Mental Health of this patient is the trigger for their colon problems irritable, sometimes we are failing just by not relating the parts of the circuit, I have an irritable colon that I have to treat because I have to treat the gastrointestinal system, I am not saying that the gastrointestinal system should not be treated, I am saying that we have to look further from this (gut-brain axis via top-down)
We have said it is a bidirectional axis and The vagus nerve and the autonomic system, Notice how interesting the vagus nerve and the autonomic system are linked to all, all the conditions that we have put here and all the conditions that we have put here are all linked to dysfunctions of the regulation of autonomic nervous system, absolutely all, All are linked to alterations of the autonomic nervous system and poor regulation of the vagus nerve, and today there are many studies that talk about this entire system, papers that talk about the relationship between microbiota of the gut-brain axis, from motility, to humor, from gastrointestinal motility, the microbiota generating changes in this function of the gut-brain axis, which will produce changes from gastrointestinal motility, we can also relate the dysfunctions of the microbiota, gastrointestinal dysfunctions to disorders of the central nervous system, disorders of the central nervous system a lot of research is being done in this regard to see Parkinson’s if a lot of research is being done regarding Alzheimer’s, and it is
studying all this because one of the best elements of the regulation of the nervous system is the system gastrointestinal, and the other way around too.
A cross communication for example between the system and depression, depression is one of the top conditions that is linked to poor function of the pathways.
The vagus nerve is a modulator of the Gut Brain axis in psychiatric conditions and in inflammatory conditions (chronic low back pain for example) as I mentioned before as a modulator of all this or not but the vagus nerve as a communicator as a transmitter of all this, is the vagus nerve at the interface of all this, it can be a modulator or it can be a connector of all that. Because the neurobiology of stress.
who here has not heard that stress
influences gastrointestinal function? Who has not found out? We see, we do not know that stress influences in existence in the gastrointestinal system ?
The sympathetic and vagus system influence the gastrointestinal system which can influence in a direction of constipation as well as including in a direction of diarrhea that is to say a dysfunction, a high altered processing that is generating changes in a low function, however we can’t limit we can’t limit the disorders the dysfunctions of the gut-brain axis to that we have here.
What we have here we cannot limit it only to digestive problems, that is a lot, it is a lot but not we can limit ourselves to this, it is much more than all this, so we have to widen our gaze widen the therapist’s gaze.
it is very easy to identify because because the patient is telling you, it is not necessary to discover that the patient is suffering from anxiety ,you see in the patient’s behavior it is not necessary to discover that he is under chronic stress, you do not have to discover in the patient’s behavior that he has visceral pain, then he has inflammation.
You see it In the patient’s clinical signs then to discover these things you don’t have to be a genius because the patient tells you and if the patient tells you, no
you need to discover it, so the issue is we are going to really work on this, as a symptom as the main condition, not back pain, or insomnia, or neck pain, but working all this as a dysfunction of the autonomous system. Knowing considering this is an answer
This is not a question. it is an answer
for example, the pain when I tell them
This hurts, it’s a question, Well answer .
But at least this is a question or an answer,
when I say “my back hurts” -Is it a question?
or is it an answer? What is your opinion ? when I say “I am anxious, I suffer from anxiety” that is either a question or an answer. what do you think?
is an answer , and if it is an answer; we can’t treat the answer, why can’t I treat the answer Miguel? because If you don’t like the answer, you treat your client by changing the question, that is, the information that reaches the nervous system.
Treating the response does not lead anywhere, an anti-inflammatory treats the response when I have pain But why do I have pain? This is the question. a medication to sleep is going to put meto sleep at night but the question is: why can’t I catch sleep? the issue is not to eliminate the symptoms is understand -Why are they being generated? Because the body is not adapting? What is the wrong question?
Why does the body not adapt? This is the question! Ok then when we talk about the intestine axis or the brain, we have to link all this to choose who we work on.
who works with chronic pain ?
there are many people who work with chronic pain, people who have patients in their clinic in their daily routine who suffer with chronic pain that has no solution, his chronic pain and has already sought 500 different therapists but It is not resolved, he does not know what else to do, you have patients like that. yes or no? let’s see what we have? what do you think of the keto diet?So if it is well indicated I love it- ketogenic for me is the best there is and it is the diet talking about the gastrointestinal system of vagus ( autonomic nervious system) it is one of the most anti-inflammatory diets
But it has to be well indicated because if we are not looking for a solution to a problem ,we still know, there we return to the topic of the answer and the question, we work very well with clear pain. Yes?
true, Well then chronic pain we have to consider: This dysfunctions of the gut-brain axis if we work with attention deficit and hyperactivity disorders, it is also related to axis disorders and Parkinson’s like migraines, insomnia, diabetes, metabolic conditions
How nice, right? A lot of things, yes there is more, there is more,, for example obesity, multiple sclerosis, chronic stress, colon irritable, functional gastroesophageal reflux, chronic musculoskeletal conditions, chronic tendinopathies, endocrine conditions, thyroid disorders due ,Functional diseases of the gut-brain axis due to alterations in vagal regulation because when
we speak of the gutbrain axis, we are also speaking of the vagus nerve.
we are going to start from the bottom, we are going to start with the gut if that is okay with you, we are going to start with the gut because the gastrointestinal system in a broader way until the internal part, then we could be saying that we have a micro part, and we have a macro part , then we are going to start looking at all this from the micro to the macro, no,we aren t going to be very detailed in the cell plan, we are going to be very detailed in the relationship plan.