In this excerpt from Charlotte Watts latest publication, Yoga Therapy for Digestive Health (Singing Dragon 2018), her own journey with digestive health issues and how she overcame them is discussed, as well as the biochemistry between your gut and mind, how yoga can support the digestive system and practices to improve gut health.
One of the reasons I first came to yoga, but mostly why my practice grew, was the profound effect it had on my long-term digestive issues; crippling IBS from my early teens. I soon recognised that this expression of what I had struggled to digest, process and let go of was more than just simply fixing a body system that wasn’t functioning correctly, but that this represented a whole-body psychotherapy and voices that needed to be listened to.
My journey with yoga and health have been part of that which is described in the Bhagavad Gita (verse 6.23) as “Dissociation from the painful union with suffering”. We do not need to separate the physical and psychic pain that we experience as humans; they are simply communicating via different routes. To gather in such fracturing, I had a journey of gathering everything back to whole, back to the centre, to the midline (from where we develop out from as an embryo) - facing the often-difficult voices in my upset belly. For me, exploration of healing digestive dis-ease was very much part of my ‘coming home’ to union of mind and body.
In a culture where we can tend to live up in our heads, voices from our bellies often go unheard. Symptoms are often suppressed by medications or not viewed as relating to our lifestyles, yet we are subject to much psycho-social stress – from job, family and home worries and demands – which is felt and expressed in our physical body. If thinking rather than feeling runs the show, our mind-bodies’ needs often go unmet and we can readily see this manifesting in our gut.
Your gut feelings are true
Any discussion on gut health has to include the enteric nervous system, the independent ‘second brain’ that runs through our entire digestive tract and is about the size of a cat’s brain. There is immense communication between our gut and brains which we are only beginning to understand. Only 10% is actually from the brain-to-gut with much of this responding to outside stimulus and incoming food. The majority gut-to-brain signalling is much about digestive function, but is also reporting back on our ‘gut feelings’ - how we respond to the world around us in the same way our brains do, but on a visceral, intuitive level. This bottom-up communication occurs via the ‘wandering’ vagus nerve (see illustration) that originates in the lower brain and wraps around all of our organs, heart down to belly and reproductive organs.
The gut and the brain form from the same piece of embryonic tissue; they even share similar 90 minute sleep cycle states, with the gut showing slow-wave followed by rapid contractions and those with disturbed REM sleep showing bowel disturbances. IBS has been described as a manifestation of “derailing of the brain-gut axis” (Gut, 1997; 390-3) and also related to disturbances in interoception; how we sense our inner landscape (Schleip R et al, 2012).
Tuning into the visceral feelings of our breath in our belly can invite attention down away from the mind preoccupations that keep us in the perpetual states of stress and worry that can affect digestion in many ways:
- The struggle to normalisation gut motility that can result in constipation, diarrhoea or the alternating between the two so common in IBS.
- Create inflammation states and Inflammatory Bowel Diseases such as colitis and Crohn’s Disease.
- Be related to diaphragmatic holding and visceral tension that are contributing factors in conditions such as haemorrhoids, diverticulitis and hernias.
- Create the stomach acid imbalances and oesophageal stress that can lead to heartburn and indigestion.
- Reduce levels of healthy gut bacteria (probiotics), creating the gas and bloating many experience; also related to mood issues, poor immune modulation and overall digestive function.
Belly connection
With digestive conditions shown to be nervous system related, many people are turning to practices that de-stress and also reconnect to the importance of fundamental needs like rest and self-compassion. Yoga has traditionally helped digestive upset by recognising that dropping beneath mind-fluctuations helps us release stagnant energy rising up from the lower body and the belly. When this is blocked, symptoms of anxiety and disturbance are held in the gut (Evidence Based Complementary and Alternative Medicine, 2015; Epub ahead of print).
In Ayurvedic medicine developed in India around 3,500 B.C., postural yoga (asanas) are prescribed to treat disordered levels of agni, the digestive fire believed to rise up from the belly, with meditation and breathing practices (pranayama) used to reduce the stress-related root causes. In Ayurveda, the state of Grahani can equated with what is now termed IBS - a syndrome with alteration of stool either in solid or in liquid form – viewed as an overall imbalance needing attention towards the whole functioning mind-body.
Any moderate physical activity ranging from 20 to 60 minutes, three times a week, has shown to improve symptom severity of IBS compared to controls that did no physical exercise (American Journal of Gastroenterology, 2011; 915-22). Adding in the specific mindfulness, breathing and self-compassion that an embodied yoga practice can bring, can only enhance these effects on the nervous system and reducing symptoms of digestive unease.
With so much information about our well-being travelling from gut to brain, any postural shifts that allow the digestion to function with less stress may have implications back to our ability to ‘still the mind’. Modern tendencies to hunch or slouch put pressure on the digestive organs with little opportunity for stretching or twisting them, which makes the digestive process physically more difficult.
General digestive support through yoga
Before delving into specific needs for different digestive conditions, we look at some foundational aspects to support this function of nourishment. These are key practices for the digestive system which apply to any condition; as usual though, it is individual need and response that directs what each individual needs.
The medical perspective
By the time many students come to yoga for digestive health, they may well have been through much medical investigation. This is looking for a particular pathology (named condition) via differential diagnosis, a series of steps to eliminate what something is not and assign a name to what it is. For many, their issues do not fit into any boxes or show anything ‘abnormal’ when tested via procedures such as colonoscopy or endoscopy. This requires reassurance that it is not simply “all in the mind” or “just stress”, but that the emotional and mental landscape is indeed part of the digestive. The physical component of yoga helps us to feel and recognise the truth of this and how we need embodied awareness for responses (as symptoms) to soften.
The yogic and Ayurvedic perspective
Stretching, compressing and twisting of the GI tract and viscera (organs) are a large part of supporting digestive health within yoga traditions. These are often related to specific asanas for the second chakra under the navel (svadisthana), represented by the colour orange and said to be the seat of emotion, where we can store feelings that have arisen from experiences. This correlates with neuroscientific research into how somatic markers (body state memories associated with previous feeling states) are set from positive or negative emotional responses being associated with gut reactions in similar situations. According to this theory, these body loops may play a part not only in how somebody feels at a given moment, but may also influence future planning and intuitive decision like whether we feel safe with particular people or suffer anxiety-related IBS at work (Nature Reviews Neuroscience, 2011;453-66).
Safety via the belly is can break these cycles of stress reactive symptoms, which may be seen as common emotional patterns in those who suffer digestive issues:
Sensitivity: Physical therapists working within fascia often note that more sensitive people tend to create and feel more effects from fascial adhesion, than those with more ‘hardy’ constitutions. Hypersensitivity is often equated with the vata dosha type within Ayurveda, as when vata (air) is in excess the mind can become agitated and unstable, also associated with those most prone to digestive upset. We don’t need to be predominantly vata dosha to feel these effects; they can arise from stress and feeling unsafe. Those who feel more ‘sensitive’ need to embrace this as a gift for intuition, but also recognise that they may need more recovery and alone time. Kindness to self, over a judgmental or punitive attitude to our bellies is the beginning of this tuning in to our true needs.
Anger: reactivity and intolerance are any side to digestive overload. In Chinese Medicine, the liver is the ‘seat of anger’; if it is congested or restricted we may suffer rage. The right side of the body, the solar side in yogic terms, is seen as fiery partly because the liver is here. Repressed anger (that which we hold back or fear to express) can affect the liver’s ability to metabolise, detoxify and regulate hormones. The liver breaks down complex substances – both food and emotions – and if it is overwhelmed or sluggish, prana capacity is reduced. Uddiyana bandha is like a partial liver flush. Type A types (pitta dosha) can sometimes have high stomachs and livers can become hypertonic, full of heat. The liver hardens with toxicity, heat, as liver and gall bladder have to work harder; may also cause nausea.
Stress: In Ayurveda, vata is an energy that should travel down towards the pelvis and elimination. Upward-moving vata (udvarta) is a condition related to stress and compromised digestion that instead moves toxins from the liver and large intestines to the head and neck. It is associated with stomach adhesion to the underside of the diaphragm, hindering stomach digestion.
From an Ayurvedic perspective, upward-moving vata is associated with the following conditions:
- Occasional constipation
- Indigestion and heartburn
- Food intolerances and sensitivities
- Immune issues such as hayfever, skin conditions and allergies
- Headaches
- Brain fog
- Achy neck and shoulders
- Ear, nose, throat and eye issues
- Weight gain
Recommended asana
Spinal undulations (such as cat-cow pose): opening the front body on the inhalation, back body on the exhalation connects us to spinal flow with the breath, the midline and our ever-shifting ‘centre’; also creating fascial movement around the liver, stomach, intestines and diaphragm.
Apanasana: always a good starting point to unravel from and gauge here practice unfolds from there, in terms of energy and relation to the belly on that day. It is the yoga pose most recommended for vata types and any who need its wind-releasing effects, as well as a nurturing foetal position (also good on the side or in child pose) for belly safety and nervous system soothing.
Belly Circling: a moving meditation that both soothes and catches up the mind’s attention, as well as initiating fascial slide-and-glide. From any seated position, from a lifted spine circle the whole torso. Keep the shoulders uninvolved and chin drawing lightly into the throat, so that the movement comes from the belly - front brain, jaw and eyes soft. It may feel organic to inhale as you move round and back, exhale as you sweep forward. Change direction when it feels right and fully experience the difference in flow, counter to the way you picked first. This can also be practiced sitting on a chair with thighs 90 degrees apart and feet planted, heels under knees for uplift through the front spine.
Leg motions on your back: The leg ‘cycling’ motion is one of our most natural; we can see babies do this on their backs to strengthen postural muscles (as legs relate to belly) to prepare for standing. Care-givers also do this motion for them to help relieve intestinal gas.
With continual movement, it also allows us to feel the shifting compensation of the rib cage and pelvic bowl to stabilise the lower back. Drawing the bottom ribs towards the floor to avoid pull in the lower back. Go ‘forwards’ and ‘back’, both slowly for muscle control and faster for more vigorous lymphatic effects in the colon and abdomen.
Other digestive considerations within a physical yoga practice:
- Opening up the psoas muscle that connects the legs to the torso and runs through the inner thighs, hips and groin helps relieve compression in the colon and encourages lymphatic flow that helps elimination processes. Any focussed attention on individual organs and ‘gut feelings’ may help a mindful yoga practice to cultivate positive feedback loops from the gut to the brain.
- Any stronger sequence where the feet hold up the body engage the abdominals as postural muscles with poses like downwards-facing dog (adho mukha svanasana), lunges, forward bends, wide-legged postures and twists all asking different muscle groups to lengthen and strengthen. It is crucial to focus on long and spacious breaths when postures get stronger so that the belly continues to receive the messages that strengthening doesn’t need to set off stress responses that add to IBS.
- Squatting positions are natural for encouraging the muscular actions needed for bowel movements; engaging lower abdominal muscles massage the colon and remind it that it might like to get going where constipation an issue. We don’t tend to squat with modern furniture and digestion can suffer.
- Back bends create space for digestion, particularly in the duodenum, the first part of the small intestine just below the breastbone where we can feel emotions intensely and the heat of heartburn. On the floor they also squeeze digestive organs for an inner massage as we breathe.
- Holding inversions and forward-bends helps reposition and compress the digestive organs to stimulate and modulate correct action.
Other practices
Oral health: the bacterial environment within our mouth and throat plays a large part in what goes on further down, as this is the first port of defence and we swallow anything present there with the food and saliva mix. Teeth and tongue cleaning are part of yoga kriyas (cleansing practices or shatkarmas) and the nasal clearing practice of jala neti uses a neti pot to run a saline solution through the sinuses, which also affect the mouth and immune system. You can see many instructions online.
Nauli: another of the six purifications (shatkarmas) is this ‘stomach-churning’ practice, where the rectus abdominis muscle (“abs”) is isolated, drawn in and eventually rolled in both directions during a retained exhalation. It is best learnt with a teacher as like kapalabhati, may not suit those who tend to anxiety - or needs building up very gently – with relaxed attention.
Mindfulness of breathing: observe rise up the body with the in-breath, drop with the out-breath can help to balance the constant interplay of prana and apana between top and bottom body – in meditation or asana.
Mindful eating: our jaw muscles are the most powerful in the body, yet are weakened by mushy diets. The chewing needed to break down food in its most natural state helps digestion, immunity, hormone balance, skin, heart, brain and every other aspect of health. Full chewing and mindful eating help foster a new habit of slowing down to eat, as well as releasing tension in the jaw that mirrors that in the belly.
Precautions and considerations to practice
If you are a teacher, listening to a student’s personal experience and trepidation is key to allowing them to meet their gut voices from a place where safety and acceptance can grow. This is also part of the journey of trust with a student; recognising that we cannot feel what another feels. Our role as a guide is to help them foster resources of listening and responding, self-compassion and attunement to the breath as their most trusted moment-to-moment foundation.
