The Stress Response & The Relaxation Response. Living (Well!) with Gastroparesis Program Class 4

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1 The Stress Response & The Relaxation Response Living (Well!) with Gastroparesis Program Class 4

2 Why is stress so important? How we think about, react to, and handle stress effects: digestive symptoms/gastroparesis secondary symptoms of gastroparesis healing long-term/overall health Chronic stress, worry, and anxiety combined with lack of a purposeful relaxation practice can make all other areas of the management plan less effective.

3 The Stress Response: Fight or Flight Stressful situation Triggers the sympathetic nervous system Adrenaline/epinephine is released increases your heart rate, elevates your blood pressure, boosts energy supplies Cortisol is released increases blood sugar, enhances your brain's use of glucose, alters immune system responses, suppresses the digestive system, suppresses the reproductive system, suppresses growth processes

4 Problem: Chronic Stress If stress is acute, short-lived, and infrequent, hormone levels go back to normal and regular bodily functions resume after danger/stress has passed. When stress is on-going, the body releases stress hormones almost constantly (50 times per day on average!). The long-term, repeated activation of the stress response results in a build up of cortisol and other stress hormones in the body.

5 Symptoms Caused by Chronic Stress Inability to focus/brain fog Chest pain/rapid heartbeat Anxiety/panic/depression Adrenal fatigue (weight loss, low blood pressure, hair loss, lightheadedness) Increased pain sensations muscle aches, backaches, headaches Dry mouth/difficulty swallowing Cold or sweaty hands and feet Angry or emotional outbursts Difficulty falling or staying asleep (feeling tired yet wired ) Chronic fatigue (tired even after sleeping) Weight gain (even if you re not eating much; especially around the middle) Poor immune function (get sick easily or stay sick longer) Carb/sugar cravings (due to blood sugar swings) Lack of sex drive Irregular menstrual periods and/or decreased fertility Constipation/diarrhea

6 How Stress Affects Healing [O]ur bodies are beautifully equipped with natural self-repair mechanisms that fight cancer, prevent infection, repair wounds, protect us from infectious agents and foreign bodies, and even affect how our genes express themselves! But here s what most people don t know. These natural self-repair mechanisms get deactivated when your body is full of stress hormones like cortisol and epinephrine in fight-or-flight mode. When your amygdala thinks you re about to get eaten by a mountain lion, the body isn t worried about preventive maintenance and the body s self-repair operations halt until the threat is over. ~ Dr. Lissa Rankin, Mind Over Medicine

7 How Stress Immediately Disrupts Digestion When you re in the Stress Response as much as four times less blood flow to the gut decreased flow of oxygen to your gut stomach stops churning colon slows down metabolism slows down decreased enzyme production (up to 20,000-fold) decreased nutrient absorption

8 "Stress can cause your esophagus to go into spasms. It can increase the acid in your stomach causing indigestion. Under stress, the mill in your stomach can shut down and make you feel nauseous. Stress can cause your colon to react in a way that gives you diarrhea or constipation." ~Kenneth Koch, motility specialist at Wake Forest

9 Gastroparesis, Cortisol & Serotonin 90+ % of our body s serotonin is found in the gut Serotonin plays a big role in motility, secretions, and signaling within the GI tract Decreased levels of serotonin have been indicated in functional GI disorders Medications for nausea/vomiting and constipation target serotonin receptors; SSRI antidepressent prevent reuptake of serotonin Increased levels of cortisol (which happens with prolonged stress) suppress the production of serotonin

10 What s triggers the Stress Response? External: career, family, finances, obligations Internal: beliefs, thoughts, fears, stories, messages we hear from ourselves or others, including beliefs about stress Lifestyle: diet, sleep habits, toxins, physical activity Gastroparesis and gut-dysfunction Few things are more distressing than an inefficient gut with feeling. Michael Gershon, MD

11 Gut-Brain Connection

12 Bidirectional Signals In the womb, the nerves that eventually separate into the brain, spinal cord and nerves of the gut all have the same beginnings and remain interconnected. Brain Gut : Anxiety can trigger stomach pain. Gut Brain: Stomach pain can trigger anxiety. Mental Distress Digestive Distress Digestive Distress Mental Distress

13 The Enteric Nervous System: Our Second Brain Role is to manage every aspect of digestion, from the esophagus to the stomach, small intestine and colon. Part of the Autonomic Nervous System, along with parasympathetic and sympathetic nervous systems. There are more nerve cells than in the entire spinal cord. Makes use of more than 30 neurotransmitters, most of which are identical to the ones found in CNS. Sends signals to the Central Nervous System. 90 % of the fibers in the vagus nerve carry information from the gut to the brain and not the other way around!

14 Regardless of where the stress is coming from, the result is the same. What to do?

15 Relaxation Response: Rest & Digest Opposite to the stress response: Parasympathetic nervous system takes over Heart beats slower and your muscles relax Breathing becomes slower Blood pressure decreases Levels of nitric oxide are increased To the extent that a condition/symptom is being caused or worsened by stress, that s the extent to which consistent practice of the Relaxation Response can help.

16 Ways to Evoke Relaxation Response A variety of different relaxation techniques can help bring your nervous system back into balance: Imagery Progressive muscle relaxation Repetitive prayer Mindfulness meditation Repetitive physical exercises (yoga/tai Chi/mindful walking) Breathing exercises Relaxation Response exercise Goal: practice for minutes per day.

17 Tips for a Relaxation Practice Just do it: in the beginning you may be resistant or it may feel uncomfortable; it ll get easier as you go. Choose the activity that s best for you: there are a variety of options; experiment until you find one that you like. Schedule a time to practice every day: first thing in the morning or in the late afternoon work well for many people. Whenever works best for you so that you ll do it consistently. Avoid practicing when you re sleepy: You will get the most benefit if you practice when you re fully awake and alert. Expect ups and downs. Don t beat yourself up if you miss a day or two. Just get back into a routine as soon as possible.

18 Other Ways to Reduce Cortisol Limit or eliminate caffeine Stabilize blood sugar with well-balanced, nutrient-rich meals Get adequate, high-quality sleep Try acupuncture Get regular massages Laugh more Practice yoga or Tai Chi Be creative Alleviate loneliness/connect with others

19 Action Steps 1. Fill out the Identify Your Stressors worksheet. 2. Choose a Relaxation Response-provoking exercise and choose a day to begin practicing (the sooner, the better!). 3. Review the GPer s Guide to Stress Management. 4. Choose one or two ways to start reducing the cortisol levels in your body and do them this week. 5. If you struggle with anxiety or stress related to coping with GP, consider listening to Coping, Stress & Anxiety Summit, which is listed as optional material in this module.

20 Class 4 Notes: Questions for Office Hours:

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