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The down & dirty on women's wellness


Irritable Bowel

Listen to Your Gut(s): What Your Digestive Processes Are Telling You & Why They Matter

March 2, 2020

I have had cause recently to think about intuition and the importance of heeding it, which has led me several times in the past week to ponder the idiomatic expression, “listen to your gut.” For clinical reasons, I have been thinking a lot during this same time about women’s digestive processes, and, as it turns out, the idiom is not just a random expression; rather, it is an old adage that possesses wisdom exceeding anything we understood in the medical world until very recently.  


Our intuition, our sense of well-being, our uneasiness are all intrinsically tied to our guts. The mind-gut connection, the link between our emotional states and our digestion, is so deeply entwined that it is fair to say we have a sort of primitive brain in our bowels. In fact, running the length of our entire digestive tract, from the openings of our mouths to the exits of our anuses is a different kind of brain called the enteric nervous system (ENS). The ENS is composed of two thin layers of more than 100 million nerve cells lining your entire gastrointestinal tract. While the ENS differs from the central nervous system (CNS) that controls our conscious thoughts and actions, it communicates directly and readily with our conscious brains.


The ENS may trigger big emotional shifts, such as those experienced by people who are coping with irritable bowel syndrome and functional bowel problems such as constipation, diarrhea, bloating, pain and stomach upset. Up to 40 percent of the population experiences functional bowel problems at some point in their lives, and these affected individuals are likely to be told that their anxiety and depression cause their problems. Recent studies, however, have demonstrated that the causality is the other way around: irritation in the gastrointestinal system sends signals to the CNS that trigger mood changes, resulting in anxiety and depression.


In fact, the gut produces neurotransmitters that are active in the brain and were long thought to arise from activity in the brain. In particular, 95% of the body’s serotonin is actually produced in the gastrointestinal tract. Serotonin is a chemical that controls and stabilizes your mood and functions in your brain. It is also crucial to the functions of your digestive system. Changes in your serotonin level affect your gut as well as your brain, impacting your pooping patterns as much as your mood. Serotonin affects many aspects of your gut function, including: how fast food moves through your system, how much fluid is secreted in your intestines and how sensitive your intestines are to sensations like pain and fullness from eating. Serotonin in the brain is thought to regulate anxiety, happiness, and mood. Low levels of the chemical have been associated with depression, and increased serotonin levels brought on by medication are thought to decrease arousal and increase fatigue. 


Serotonin is made from the essential amino acid tryptophan, which we associate with the sleepiness that sets in after eating turkey at Thanksgiving. This amino acid must enter your body through your digestive and is commonly found in foods such as nuts, cheese, and meat. Problems with absorbing or limitations on consumption of any of these foods can cause tryptophan deficiency, which can lead to lower serotonin levels. This can result in mood disorders, such as anxiety or depression, or mood instability that looks like mood swings or erratic responses.


When compared to men, women are six times more likely to experience irritable bowel syndrome, and the fluctuations in progesterone that women experience throughout their reproductive lives affects their digestive processes, which also affects their serotonin production & the availability of serotonin in the CNS to regulate mood. Not only are women more likely than men to experience digestive woes, including chronic nausea, abdominal pain and heartburn, but female anatomy differs importantly from male anatomy in ways that impact digestive function: in a biologically female body, the colon navigates a pelvic structure and the presence of organs that differ from a biologically male body, causing a more convoluted bowel pathway. 


The female gastrointestinal tract also produces enzymes that break down ingested substances differently than a male gastrointestinal tract and the transit time for most ingested substances tends to be slower, meaning that what a woman ingests stays in her system longer than what a man ingests, including medications, which may affect women very differently than they affect men, a concept that continues to elude most medical practitioners, who still often treat women as if they are small versions of men. Most studies of medication are not conducted independently among populations of biologic females, which means we don’t always know what the response of a body affected by female digestion and enzymatic processes will be to any given medication, just as women are differently affected by consumption of preservatives, additives, and chemical components of our modern diet. Everything we ingest, therefore, is also potentially affecting our brains’ functions, the other bodily processes mitigated by serotonin (sleep, wound healing, blood clotting, sexual functioning, bone growth), and our moods.


Listen to your guts, ladies. Ingest mindfully. Pay attention to how your body digests what you’re feeding it. Constipation is meaningful. Diarrhea is meaningful. Abdominal pain is meaningful. Chronic nausea is meaningful. AND: your anxiety and depression are at once equally meaningful and inextricably connected.