An ancient solution for a modern problem First published Spring 2019 We find out how yoga may help to ease the symptoms of IBS and other digestive problems Yoga may be rooted in ancient Hinduism but, for many, it is less about spirituality and more about health. The NHS states on its website that evidence shows yoga can benefit people with high blood pressure, heart disease, aches and pains including lower back pain, depression and stress. Charlotte Watts, a registered nutritional therapist, senior yoga teacher and author of Yoga for Digestive Health, would also add digestive problems such as irritable bowel syndrome (IBS) to the list. A common gut problem that can cause stomach pain, bloating, constipation and diarrhoea, IBS affects thousands of people in the UK. Although some studies have indicated that yoga could relieve its symptoms,1,2 it’s not known exactly why. However, stress — often a trigger for IBS — is likely to be key. Watts says various studies have shown that yoga reduces stress and inflammatory markers such as cytokines, which are associated with stress. “This is particularly good news for those with the IBS, Crohn’s disease and ulcerative colitis,” she says. “Those who practise yoga and meditation know this to be true, but the evidence is building to also show that such practices of ‘embodied awareness’ — like t’ai chi and qi gong — help reduce the trauma symptoms also related to digestive issues.” Watts credits yoga with helping her own recovery from “crippling IBS” which she suffered with from childhood. And now, even with her training and experience in nutritional therapy, she does not believe that her recovery from IBS would have been as successful without yoga. Movement Lack of movement, bad posture and stress, Watts says, can all impact the smooth functioning of the gut. “We are built to move… in all directions to keep us nicely oiled internally, so that organs can move freely... When we don’t have this ‘slide-and-glide’, as it is referred to, we can feel those restrictions as pain, pulls or discomfort in the digestive and reproductive areas.” She adds that fascial research (relating to connective tissue) is uncovering the importance of movement between organs, and how lesions and adhesions — something she describes as “stickiness” — from lack of movement can affect digestion, how we move, and even lower back pain. “Yoga practices that undulate the spine (such as cat-cow pose), twist around the middle and create pulsing movements into the fascia, help break down these adhesions and restore function,” she says. “Simply learning to move ‘from the belly’ over time loosens us up from the centre, which also helps gut motility — the inner movements on the gut wall that keep the gut bacteria in the right place and allows full digestion.” Stress and anxiety Stress, says Watts, can interrupt the digestive system and prevent us from fully breaking down food. “This can lead to partially digested food hanging around and even putrefying” which, she says, can lead to gas and bloating. “Stress also depletes our beneficial bacteria, which leaves us more susceptible to digestive issues [and] depletes the mineral magnesium that we need to both activate the parasympathetic nervous system [the nervous system that activates the digestive system] and regulate bowel muscle movement.” She says that this can be particularly related to alternating constipation and diarrhoea — common in IBS — “when the bowel struggles to find normal balance”. There is a bit of an obsession with core work in both yoga and other forms of exercise... it can restrict movement in the belly and diaphragm... In Watts’ own experience, anxiety was also a trigger. “I was extremely anxious at the time,” she says. She describes her physical symptoms as “being an expression of feeling generally unsafe and being in continual fight, flight or freeze survival mode”. In the right situation, fight or flight can save our life. But modern-day stresses leave many of us in a constant state of stress or anxiety for which there is no outlet. In her own case, says Watts, anxiety led to the feeling of constriction and pain in her gut. “Chronic pain is a signal that something isn’t being listened to,” she says. Yoga, however, enabled her to learn to tune into her gut’s physical responses “rather than further tense away from them, compounding the problem”. She explains that yoga also gave her the tools to breathe fully and be kinder to herself. “Offering kindness to my body and learning to breathe into my belly played a massive part in unravelling the root causes of my IBS.” WHAT'S IN A NAME? Traditional yoga forms with both asanas and pranayama — recommended for the beginner: Hatha, Iyengar, Svaroopa, Sivananda yogas With the emphasis on active movement through a series of postures, yoga forms that can be quite demanding requiring upper body strength: Ashtanga, Dynamic, Power, Bikram/Hot yogas (in Bikram the movements are performed in a very warm room) Passive forms with little or no asanas but with more emphasis on breathing and meditation — not for those who feel the need to work out: Kundalini, Rajah, Ananda yogas. Bad posture She also describes how poor posture can affect the digestive system; sitting hunched over or in chairs for long periods of time or with posture that she describes as a “chest collapse that is associated with depression”.... a position that “leaves little room for the organs to function optimally and for the diaphragm to move fully”. Go slow If you are tempted to try yoga as a possible aid for digestive problems, Watts cautions that not all yoga classes might be helpful. “Many forms are very dynamic and fast-moving and don’t allow much time for tuning in to body responses,” she says. “This can feed into habits of doing more, and faster, which are the very habits that feed into high stress levels and affect digestive capacity. “I often… direct people towards awareness of diaphragmatic and belly breathing... rather than the more stress-induced breathing up into the chest and shoulders, which also keeps tension in the jaw that relays down to the gut.” Exercise that focuses on strengthening the core also might not be helpful. “There is a bit of an obsession with core work in both yoga and other forms of exercise,” she says. “[But] it can restrict movement in the belly and diaphragm. We need this for full digestion — to allow full movement of the stomach, massage organs and for the downward motion of defecation.” Getting started Although there are many free online yoga demonstrations or apps, it is recommended to attend classes with a qualified instructor who can ensure that you are practising yoga safely and effectively. IBS, YOGA AND RESEARCH A systematic review of six randomised controlled trials (RCTs) with a total of 273 patients found that there was evidence yoga had benefits over conventional IBS treatment, with significantly decreased bowel symptoms, IBS severity, and anxiety. Furthermore, there were significant improvements in quality of life and physical functioning after yoga, compared with no treatment. However, the authors of the systematic review stated that any bias in the included studies was unclear. They also concluded that no recommendations could be made regarding yoga as a routine intervention for IBS. This was because of major flaws in methods used in the RCTs; but they did recommend that further, high-quality research was needed.3 Yoga Therapy for Digestive Health by Charlotte Watts is published by Singing Dragon. Contact Charlotte Watts at: www.charlottewattshealth.com Read more articles and recipes References Kuttner L et al (2006). A randomized trial of yoga for adolescents with irritable bowel syndrome. Pain Res and Management, 11(4): 217-224. Kavuri V et al (2015). Irritable bowel syndrome: Yoga as remedial therapy. Evidence-Based Compl and Alt Med. Schumann D et al (2016). Effect of yoga in the therapy of irritable bowel syndrome: A systematic review. Clin Gastroenterol and Hepatol, 14.12:1720-1731.