The Gut-Brain Axis, Autonomic Nervous System and IBD:
The gut-brain axis is a core component of gut health and plays a key role in inflammatory bowel disease (IBD). Specifically, the autonomic nervous system is made up of the sympathetic and parasympathetic nervous systems that regulate involuntary body processes including digestion through the brain-gut axis. The vagus nerve plays a key role in the gut brain axis modulating the parasympathetic nervous system.
Previous research has shown an imbalance between the sympathetic and parasympathetic nervous system in IBD patients, especially right before and during flares of acute inflammation. Specifically, there is decreased vagal nerve activity with a low heart rate variability (HRV). Studies show that using a heart monitor (EKG) to measure HRV helps distinguish between active and inactive IBD, with a lower HRV indicating active IBD. HRV monitoring may even be used for early detection of IBD flares, allowing for timely intervention and preventing clinical deterioration.
Vagus Nerve and IBD Healing
The autonomic nervous system can also be modulated through the vagus nerve to assist healing IBD – especially considering the limitations of current IBD treatment including side effects, incomplete efficacy and high costs. The vagus nerve has anti-inflammatory effects through the hypothalamic-pituitary adrenal axis, or activation of the cholinergic anti-inflammatory pathway (the inflammatory reflex). The vagus nerve can stop the release of pro-inflammatory cytokines, such as tumor necrosis factor (TNF). It also plays an important role in the microbiota-gut-brain axis and modulates gut permeability through enteric nerves. The vagus nerve also has anti-pain properties.
Vagal nerve stimulation (VNS) and mind-body practices are investigational therapies targeting the nervous system to treat IBD through the ‘inflammatory reflex’ that reduces systemic inflammation.
Clinical Studies
In the Journal of Crohn’s and Colitis, D’Haens et al studied the efficacy and safety of VNS in sixteen adult patients with moderately-to-severely active Crohn’s disease refractory to biologics, in a 16-week clinical trial. Patients were implanted with an electrode around the left vagus nerve and linked to a neurostimulator. At week 16, there was a significant decrease in the Crohn’s Disease Activity Index (CDAI), quality of life, fecal calprotectin (gut inflammation), mucosal inflammation, and inflammatory cytokines. VNS was well tolerated and safe.
Another study from Sahn et al investigated VNS in IBD patients 10-21 years of age with mild/moderate Crohn’s disease or ulcerative colitis who did not achieve remission with standard therapy, and a fecal calprotectin >200 ug/g . Vagus nerve stimulation was conducted using a transcutaneous electrical nerve stimulator unit targeting the external left ear. At week 16, 50% of IBD subjects achieved clinical remission. Importantly, there were no safety concerns.
Mind–body approaches including breathing techniques such as Voluntarily Regulated Breathing Practices (VRBPs) affect IBD through the autonomic nervous system, inflammation, and the hypothalamic–pituitary–adrenal axis. Mind–body practices can reduce anxiety and stress which have been estimated to play a role in up to 80% of IBD flares and affect both quality of life and severity of IBD symptoms. Slow VRBPs reduce sympathetic overactivity, increase parasympathetic activity, and can reduce inflammation by trigger anti-inflammatory cascades.
A 2015 study published in Inflammatory Bowel Diseases found that participation in a Breath–Body–Mind Workshop (BBMW) was associated with significant subacute and long-term improvements in psychological symptoms (anxiety, depression, perceived disability, and perceived stress), physical symptoms (bowel symptoms, systemic symptoms, and pain), and quality of life in IBD patients. In addition, BBMW participants had significant reductions in the inflammatory marker CRP after 26 weeks.
Final Thoughts
For a holistic, comprehensive approach to healing in IBD, look beyond standard tools and medications. Although medication can induce remission– long-term success can only be achieved by understanding that IBD is a multifaceted condition and addressing components such as the gut-brain axis beyond the prescription pad.
Dr. Elena Ivanina is the founder and visionary behind Gut Love. She is a gut doctor in NYC who specializes in holistic, natural cures for gut conditions and health. Dr. Ivanina is board-certified in gastroenterology, internal medicine, preventative medicine and public health, and obesity medicine, having received her Master’s in public health after medical school. Through Gut Love, Dr. Elena Ivanina offers medical consultations as well as remote educational sessions to patients all over the world to help them on their journey to gut health using holisitic, proven alternative methods. Follow her on Instagram @gut_love and email her at info@gutlove.com.
Dr. Elena Ivanina, MD
