# The Other Brain Also Deals With Many Woes



## Jeffrey Roberts

http://www.nytimes.com/2005/08/23/health/23gut.htmlAugust 23, 2005The Other Brain Also Deals With Many WoesBy HARRIET BROWNTwo brains are better than one. At least that is the rationale for the close - sometimes too close - relationship between the human body's two brains, the one at the top of the spinal cord and the hidden but powerful brain in the gut known as the enteric nervous system.For Dr. Michael D. Gershon, the author of "The Second Brain" and the chairman of the department of anatomy and cell biology at Columbia, the connection between the two can be unpleasantly clear. "Every time I call the National Institutes of Health to check on a grant proposal," Dr. Gershon said, "I become painfully aware of the influence the brain has on the gut." In fact, anyone who has ever felt butterflies in the stomach before giving a speech, a gut feeling that flies in the face of fact or a bout of intestinal urgency the night before an examination has experienced the actions of the dual nervous systems.The connection between the brains lies at the heart of many woes, physical and psychiatric. Ailments like anxiety, depression, irritable bowel syndrome, ulcers and Parkinson's disease manifest symptoms at the brain and the gut level. "The majority of patients with anxiety and depression will also have alterations of their GI function," said Dr. Emeran Mayer, professor of medicine, physiology and psychiatry at the University of California, Los Angeles.A study in 1902 showed changes in the movement of food through the gastrointestinal tract in cats confronted by growling dogs.One system's symptoms - and cures - may affect the other. Antidepressants, for example, cause gastric distress in up to a quarter of the people who take them. Butterflies in the stomach are caused by a surge of stress hormones released by the body in a "fight or flight" situation. Stress can also overstimulate nerves in the esophagus, causing a feeling of choking.Dr. Gershon, who coined the term "second brain" in 1996, is one of a number of researchers who are studying brain-gut connections in the relatively new field of neurogastroenterology. New understandings of the way the second brain works, and the interactions between the two, are helping to treat disorders like constipation, ulcers and Hirschprung's disease.The role of the enteric nervous system is to manage every aspect of digestion, from the esophagus to the stomach, small intestine and colon. The second brain, or little brain, accomplishes all that with the same tools as the big brain, a sophisticated nearly self-contained network of neural circuitry, neurotransmitters and proteins. The independence is a function of the enteric nervous system's complexity."Rather than Mother Nature's trying to pack 100 million neurons someplace in the brain or spinal cord and then sending long connections to the GI tract, the circuitry is right next to the systems that require control," said Jackie D. Wood, professor of physiology, cell biology and internal medicine at Ohio State.Two brains may seem like the stuff of science fiction, but they make literal and evolutionary sense."What brains do is control behavior," Dr. Wood said. "The brain in your gut has stored within its neural networks a variety of behavioral programs, like a library. The digestive state determines which program your gut calls up from its library and runs." When someone skips lunch, the gut is more or less silent. Eat a pastrami sandwich, and contractions all along the small intestines mix the food with enzymes and move it toward the lining for absorption to begin. If the pastrami is rotten, reverse contractions will force it - and everything else in the gut - into the stomach and back out through the esophagus at high speed. In each situation, the gut must assess conditions, decide on a course of action and initiate a reflex. "The gut monitors pressure," Dr. Gershon said. "It monitors the progress of digestion. It detects nutrients, and it measures acid and salts. It's a little chemical lab."The enteric system does all this on its own, with little help from the central nervous system. The enteric nervous system was first described in 1921 by Dr. J. N. Langley, a British physician who believed that it was one of three parts - along with the parasympathetic and sympathetic nervous systems - of the autonomic nervous system, which controls involuntary behaviors like breathing and circulation. In this triad, the enteric nervous system was seen as something of a tag-along to the other two. After Langley died, scientists more or less forgot about the enteric nervous system. Years later, when Dr. Gershon reintroduced the concept and suggested that the gut might use some of the same neurotransmitters as the brain, his theory was widely ridiculed."It was like saying that New York taxi drivers never miss a showing of 'Tosca' at the Met," he recalled.By the early 80's, scientists had accepted the idea of the enteric nervous system and the role of neurotransmitters like serotonin in the gut. It is no surprise that there is a direct relationship between emotional stress and physical distress. "Clinicians are finally acknowledging that a lot of dysfunction in GI disorders involves changes in the central nervous system," said Gary M. Mawe, a professor of anatomy and neurobiology at the University of Vermont.The big question is which comes first, physiology or psychology?The enteric and central nervous systems use the same hardware, as it were, to run two very different programs. Serotonin, for instance, is crucial to feelings of well-being. Hence the success of the antidepressants known as S.S.R.I.'s that raise the level of serotonin available to the brain. But 95 percent of the body's serotonin is housed in the gut, where it acts as a neurotransmitter and a signaling mechanism. The digestive process begins when a specialized cell, an enterochromaffin, squirts serotonin into the wall of the gut, which has at least seven types of serotonin receptors. The receptors, in turn, communicate with nerve cells to start digestive enzymes flowing or to start things moving through the intestines. Serotonin also acts as a go-between, keeping the brain in the skull up to date with what is happening in the brain below. Such communication is mostly one way, with 90 percent traveling from the gut to the head.Many of those messages are unpleasant, and serotonin is involved in sending them. Chemotherapy drugs like doxorubicin, which is used to treat breast cancer, cause serotonin to be released in the gut, leading to nausea and vomiting. "The gut is not an organ from which you wish to receive frequent progress reports," Dr. Gershon said.Serotonin is also implicated in one of the most debilitating gut disorders, irritable bowel syndrome, or I.B.S., which causes abdominal pain and cramping, bloating and, in some patients, alternating diarrhea and constipation. "You can run any test you want on people with I.B.S., and their GI tracts look essentially normal," Dr. Mawe said. The default assumption has been that the syndrome is a psychosomatic disease. But it turns out that irritable bowel syndrome, like depression, is at least in part a function of changes in the serotonin system. In this case, it is too much serotonin rather than too little.In a healthy person, after serotonin is released into the gut and initiates an intestinal reflex, it is whisked out of the bowel by a molecule known as the serotonin transporter, or SERT, found in the cells that line the gut wall.People with irritable bowel syndrome do not have enough SERT, so they wind up with too much serotonin floating around, causing diarrhea. The excess serotonin then overwhelms the receptors in the gut, shutting them down and causing constipation.When Dr. Gershon, whose work has been supported by Novartis, studied mice without SERT, he found that they developed a condition very much like I.B.S. in humans.Several new serotonin-based drugs - intestinal antidepressants, in a way - have brought hope for those with chronic gut disorders.Another mechanism that lends credence to physiology as the source of intestinal dysfunctions is the system of mast cells in the gut that have an important role in immune response."During stress, trauma or 'fight or flight' reactions, the barrier between the lumen, the interior of the gut where food is digested, and the rest of the bowel could be broken, and bad stuff could get across," Dr. Wood said. "So the big brain calls in more immune surveillance at the gut wall by activating mast cells." These mast cells release histamines and other inflammatory agents, mobilizing the enteric nervous system to expel the perceived intruders, and causing diarrhea. Inflammation induced by mast cells may turn out to be crucial in understanding and treating GI disorders. Inflamed tissue becomes tender. A gut under stress, with chronic mast cell production and consequent inflammation, may become tender, as well. In animals, Dr. Mawe said, inflammation makes the sensory neurons in the gut fire more often, causing a kind of sensory hyperactivity. "I have a theory that some chronic disorders may be caused by something like attention deficit disorder in the gut," he said. Dr. Gershon, too, theorizes that physiology is the original culprit in brain-gut dysfunctions. "We have identified molecular defects in the gut of everyone who has irritable bowel syndrome," he said. "If you were chained by bloody diarrhea to a toilet seat, you, too, might be depressed." Still, psychology clearly plays a role. Recent studies suggest that stress, especially early in life, can cause chronic GI diseases, at least in animals. "If you put a rat on top of a little platform surrounded by water, which is very stressful for a rat, it develops the equivalent of diarrhea," Dr. Mayer said. Another experiment showed that when young rats were separated from their mothers, the layer of cells that line the gut, the same barrier that is strengthened by mast cells during stress, weakened and became more permeable, allowing bacteria from the intestine to pass through the bowel walls and stimulate immune cells."In rats, it's an adaptive response," Dr. Mayer said. "If they're born into a stressful, hostile environment, nature programs them to be more vigilant and stress responsive in their future life."He said up to 70 percent of the patients he treats for chronic gut disorders had experienced early childhood traumas like parents' divorces, chronic illnesses or parents' deaths. "I think that what happens in early life, along with an individual's genetic background, programs how a person will respond to stress for the rest of his or her life," he said.Either way, what is good for one brain is often good for the other, too. A team of researchers from Penn State University recently discovered a possible new direction in treating intestinal disorders, biofeedback for the brain in the gut. In an experiment published in a recent issue of Neurogastroenterology and Motility, Robert M. Stern, a professor of psychology at Penn State, found that biofeedback helped people consciously increase and enhance their gastrointestinal activity. They used the brains in their heads, in other words, to help the brains in their guts, proving that at least some of the time two brains really are better than one. Copyright 2005 The New York Times Company


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## Jeffrey Roberts

Letter to the NY Times Editor: Thank you for your article, â€œThe Other Brain Also Deals With Many Woesâ€ (23/8/04) by Harriet Brown. As the President & Founder of the Irritable Bowel Syndrome Association and Co-Founder of the IBS Patient Action Group, it is always heartening to see a national newspaper feature a story on IBS a condition that is too often ignored.I was pleased that you highlighted new research on the correlation between serotonin in the gut and the onset of IBS symptoms. This is an important insight into why serotonin receptor treatments like Zelnorm, a treatment for IBS Constipation sufferers, is able to provide the relief that they do. This helps assure IBS patients that itâ€™s not all in their heads and that they have a treatable medical condition. As a patient action group we are stymied to understand why the Food and Drug Administration is holding up on a medication called Cilansetron for IBS Diarrhea sufferers. Clearly experts such as Dr. Gershon and Dr. Wood have shown a clear pathway for serotonin receptor treatments so that IBS Diarrhea patients can also benefit from some relief.Thank you for helping to break the myths of IBS.Sincerely,Jeffrey D. Roberts-------------------------------------------------------------------------Jeffrey D. Roberts, B.Sc.President & FounderIBS Association Co-Founder IBSPAG


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## 14416

Thanks Jeff for all your work in the IBS community. You really are a stand-up guy.


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## lizbeth

Thanks, Jeff for this posting. I heard about this article but did not get a chance to read it. This article gives new meaning to the phrase "gut reaction"!!Can IBS be explained simply as too much or too little seratonin? Here is part of the article which I wonder about:


> quote:


But it turns out that irritable bowel syndrome, like depression, is at least in part a function of changes in the serotonin system. In this case, it is too much serotonin rather than too little.In a healthy person, after serotonin is released into the gut and initiates an intestinal reflex, it is whisked out of the bowel by a molecule known as the serotonin transporter, or SERT, found in the cells that line the gut wall.People with irritable bowel syndrome do not have enough SERT, so they wind up with too much serotonin floating around, causing diarrhea. The excess serotonin then overwhelms the receptors in the gut, shutting them down and causing constipation. When Dr. Gershon, whose work has been supported by Novartis, studied mice without SERT, he found that they developed a condition very much like I.B.S. in humans.


> quote:


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## 13922

I am glad I read this article. My doctor wants to start me on an antidepressant - but I if there is too much serotonin (cause of IBS ) won't the AD make it worse? Confused!


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## bonniei

> quote: Can IBS be explained simply as too much or too little seratonin?


Yes . It is caused by more than normal serotonin(diarrhea) and much more than normal serotonin(constipation)


> quote:but I if there is too much serotonin (cause of IBS ) won't the AD make it worse? Confused!


Too much serotonin where is the question. Not all AD's affect serotonin and mostly their effect in the brain rather than gut has been studied. Different AD's work in different ways -some like Remeron by blocking the receptors which cause diarrhea, ""Fluoxetine(Prozac) has been shown to decrease orocecal and whole gut transit times in both constipation-predominant IBS and controls. This may explain why Tabas et al. observed some benefits in terms of constipation in their trial. Venlafaxine (Effexor)(an inhibitor of serotonin and norepinephrine reuptake) has been shown to reduce colonic compliance and relax the colon in healthy volunteers "


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## SpAsMaN*

A doctor has tried to put me on Effexor once,i have declined the offer.


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## cat crazy

> quote:Originally posted by bonniei: Venlafaxine (Effexor)(an inhibitor of serotonin and norepinephrine reuptake) has been shown to reduce colonic compliance and relax the colon in healthy volunteers "


You mean that this drug is used for reducing transit time? If so then I'll ask my doc for a presx to see if it helps in my d ibs.


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## bonniei

> quote:Originally posted by hanna:You mean that this drug is used for reducing transit time? If so then I'll ask my doc for a presx to see if it helps in my d ibs.


Prosac has been shown to reduce transit, not Effexor


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## 20954

Greetings to all!As I understand all too well how debilitating and disruptive IBS can be, I'm feeling the need to share some of my past and recent discoveries on IBS and related conditions in the hope that some of you may benefit from what I've learned and had great success with, on a personal level as well as in helping people in my circle of friends and family. That and I just had a rather long chat with my sister whose IBS has been flaring something awful over the past six months and she's at the end of her rope as to what to do to alleviate her symptoms.I don't think I need to tell you all how tremendously disrupting a long period of flare-ups can be. She's desperate and the conversation we had made me realize I really do know a lot about the condition and have a deep understanding of what might cause it, what makes it worse and what alleviates it. In the short term as well as the long run.To all you others out there who may be experiencing long periods of flare-ups I want to stress one point above all else, something that most of us in our hectic "modern" lifestyles very often forget to do: STOP and LISTEN to your bodies. They are trying to tell you something's out of order by giving you symptoms.As always, the information I provide is general and may not fully apply to every individual case, but I feel fairly certain most of you will find at least some inspiration and perhaps a little comfort in what follows.Before anyone feels the need to question my knowledge on the topic, or how I arrived at my conclusions, let me just say in passing that I have been learning how to manage my own IBS for the past 10 years now, it runs in the family (my mother, aunt, sister and aunt on father's side of the family all suffer from it) and I had tried practically -every- so-called "remedy" out there before I finally settled on and fully accepted what I now know to be the truth of the matter. Let me tell you I've been almost completely symptom-free for the past year since I began devotedly "practicing what I preach" (apart from the occasional ever so naughty piece of chocolate I allow myself every now and then, which gives me a few hours of gas and bloating. Almost worth it sometimes though, isn't it?. ;o) )So, without further long-winded ado, my observations, thoughts and conclusions on the subject at hand.What truly baffles me about all the information I come across on IBS and related dis-eases (I use the word "dis-ease", not in the general sense of the word, meaning "illness or sickness", but hyphenated on purpose to describe a state of physical, mental or spiritual distress. In other words, a situation or "syndrome" as western medicine likes to label multi-symptomatic states of dis-ease, often prolonged, which falls outside the realm of what would be considered a completely healthy state) is this:Western medicine's complete disregard for, or lack of knowledge about, the spiritual state of the patient.The western medical community has slowly begun opening its eyes to the very real connections between the mind and the body, the mental/psychological states that affect the physical self and vice versa. The information posted in the beginning of this thread by Mr. Jeffrey Roberts is very real, very true and applies on a physical and psychosomatical level, yet I strongly feel that a few key points are missing. For one, I firmly believe that certain personality types are more prone to IBS than others and that once the condition has been "birthed" it generally never completely subsides, i.e. your intestines become extra sensitive and you need to manage the condition by carefully watching your intake of foods, your stress levels, etc. Also, and this is my key point, in the medical community there is talk of psychosomatical symptoms, relations between depressive states and GI dis-eases etc, yet we completely forget to take the patient's spiritual state into account. Now before you dismiss what I am about to say as something a religious fanatic would try to force upon you, let me just say this: I was never very religious, nor am I a fanatic, I am simply offering my point of view and my first-hand knowledge for the Internet community to share and hopefully benefit from.The missing link is more philosophical than medical in nature.It is love. Divine love.Pure and simple.Oh, I can almost feel the millions of objections the established medical community would have towards such a "controversial statement", and I have met and dealt with numerous such objections in the past. However, all I ask is that you hear me out. We, us humans, on the general whole, are raised in a society where very many of us are made to feel ashamed of our bodies, uncomfortable, competitive, you name it. We are seldom, almost never, taught the sanctity of our body and how it is a very real product of divine perfection. Using the buddhist and hindu faiths as an example where the body is considered a temple, I ask you this: What do people generally do in temples? They worship. Worship your bodies, love them, nurture them. Most of all, LISTEN to them. That's what I mean when I say "divine love". Unconditional Love. Listen to what your body is telling you and realize that what it's trying to say cannot be bandaged away with pills and procedures. Most prolonged states of dis-ease escalate to life-threatening levels because they are ignored or improperly handled. Over-medication is a very real issue as well. The more "foreign substances" you introduce into your system, the more difficult it becomes for your body to use its natural healing process to balance the disruptions to your overall health. I'm sure most of you have experienced entirely new symptoms stembing from side effects of experimental medication, so you know what I say is true.Trying very hard not to stray too far from the topic of the thread, a condition such as IBS (and believe me, it is far from the only condition that would benefit greatly from this approach to healing I practice and teach) needs to be carefully managed with loving intent, not ignored and "bandaged" with pills and procedures.What I've found is very often the case with prolonged cases of IBS is that your spirit, your "higher self", your subconcious, whatever you want to call it, is trying to tell you it is in a state of distress and is using your physical self as the means to relay this information. Granted, medication might alleviate certain symptoms that have been causing you discomfort over an extended period of time, but they are not a permanent solution, nor do I recommend using pills or modern snake oils for anything other than occasional symptom relief. There is also a huge resource of homeopathic and eastern remedies, which generally provide the same symptom relief as most modern medicine. These remedies have been around for thousands of years (ie have a proven track record of actually getting the job done, as opposed to most new experimental meds) and can be found in most health food stores and well-sorted pharmacies.I ask you to reflect on the following statements and questions, as a means of further understanding my point of view:Why is it that "modern medicine" has not been able to come up with a "cure" for IBS? Or even for the common cold? Why is it there is no one actual cure for dis-eases such as cancer or HIV/AIDS? Why do certain people completely recover (yes, there are documented cases of people actually completely recovering from HIV, in the cases where the dis-ease progresses into the acute stage of AIDS unfortunately I have yet to hear of complete recoveries), others going through years and years of "medicinal therapy" and treatments only to die a painful death?Because modern medicine overlooks one of the key important aspects: the spiritual connection.The physical body has an innate ability to heal itself, given the right circumstances and the right amount of faith.Faith in oneself and faith in the body's ability to heal.On the topic of why the general view of modern medicine is to bandaid symptoms rather than get to the root cause of the state of dis-ease I can offer many points of discussion and insight, mainly this one: what's behind a lot of the funding of most "modern medicine research facilities" today? Medical companies, the "legalized pill-pushers" as I choose to call them. If I may be so bold as to offer yet another controversial point of view, their marketing schemes are not so different from those of your average drug lord or the crack dealer on the street corner. What's in their best interest, to see you become healthy and not need any more medication, or to keep you coming back for more?One word, that explains it all: GREED.And the worst kind of greed too, corporate greed with legislative backing.Personally, I shudder at the mere thought of how much power these gigantic corporations hold over our heads.That's an entirely different topic though, now isn't it.Glancing at the clock, realizing that it is getting really late here and I feel like this is beginning to turn into a philosophical essay rather than the few points of insight I had originally intended it to be, I must sign off for the time being.I do however welcome any questions or even challenges to the information I have provided in my posting here tonight, in fact I encourage it. Debate is healthy and usually brings about the required/desired change. As change is the mother of growth and evolution, it can be concious and directed. Remember, without evolution, we wouldn't even be here in the first place.I will leave you all with this to pondero you want to take an active interest in your health and well being? It's a simple question, really.Ask yourself, am I willing to do what is necessary to become completely whole and healthy?If the answer is yes, my recommendation is as simple as the original question:Look into an ayurvedic diet (very lenient on the intestines and -very- healthy) and start practicing one of the physical disciplines of Yoga, Tai Chi or Qi Gong (Falun Gong/Falun Dafa) which is the absolute best way to increase body awareness and manage stress levels.It will help, I can guarantee it. It's really up to you. All you really need is the correct form and amount of guidance to get you started, the rest is up to your will and dedication to yourself and your well being.Two excellent places to start and for more information on divine love and healing are:http://www.amazon.com/gp/product/customer-...=283155&s=bookshttp://www.sanatansociety.org/No, I am not affiliated with any organisations, nor am I promoting any particular printed works, I am simply offering insight.Take it to heart or do not, the choice remains with you.In the spirit of healing,Peace, Love and Prosperity to you all.Namaste


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## 17057

Very nice, Hawk. I couldn't agree more with almost everything you said here. I think, however, that you completely discredit the medical community too readily. Yes, I spent years under the care of one GI specialist to no avail - years I wish I could get back - only to find my family doctor helped immensely with a prescription of Effexor (75mg initially, 150 later upon my request). It was not intended to help my gut, but to help me relax over the news that I was probably going to have to lose my colon. As it turned out, the Effexor calmed my condition to an acceptable level, supporting the mind over gut theory moreso than the excess in gut seratonin theory I was researching when I found this thread.I have IBD, not IBS, so draw you own conclusions from that. Effexor has proven to help me remain more peaceful and centered, as well. While I am dedicated to achieving this state naturally, I cannot say enough about how much of a godsend Effexor has been for me. Those greedy pill-pushers deserve every cent of money they get from me. I'm convinced their pursuit of riches while helping mankind have enabled me to continue the second half of my life without the incumbrance of a colostomy bag.With respect,Texas_Kev


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## eric

in IBS"mind over gut theory more so than the excess in gut seratonin theory"Is the same parts of the problem.serotonin abnormalities are confirmed in IBS.Serotonin signals sensations from the gut to the brain, which in trun sends signals back.


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## 20678

The article on the second brain is excellent and helps me with some research I am doing. I have recovered from 16 years of bulimia, which I believe started due to IBS as a child that continued to get worse and created disordered eating. Bulimia was the only way I got relief from IBS, but it was only temporary relief -- and certainly not a solution. But at the time, I didn't understand anything my body was doing.After trying everything, I went on the Body Ecology Diet (book by Donna Gates), which cures the inner ecosystem within the body. On day one of starting the diet, I no longer had IBS pain and no longer had bulimia. Not even an urge. No struggle. It was like a miracle.I was so amazed by my results that I attended Donna's Certified Body Ecologist training in Atlanta last week. There I learned things doctors don't get taught...the workings of our intestinal microflora. Now I understand why I had IBS and why I ended up developing bulima. Interestingly, both IBS and bulimia are related to the body trying to deal with serotonin 95% of serotonin is in the gut). I am now researching serotonin and whether the Body Ecology Diet can reverse the serotonin issue through rebuilding healthy microflora in the system. My theory is yes and Donna's is as well, since the Body Ecology Diet has helped reverse so many other chronic illnesses that could not be helped by Western Medicine.I highly recommend reading the book. I talk more about it and IBS in my blog: http://TranscendBulimia.comI plan to post my research findings in my blog over the next month. Heather


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## eric

It might not be an excess serotonin issue, but the regulation of the release of serotonin from specific cells in the gut called EC cells.Heather you should watch thisJust click on course presentation. You need flash for this also.http://www.ja-online.com/dukeibs/#Also serotonin is a part of IBS issues, although an inportant one.


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