Exercise is often heralded as a “wonder drug” for just about every part of the body, whether it’s the brain, the heart, the pelvic floor or the lungs. But what about the stomach?
While going for a jog with a sensitive stomach is rarely appealing, regular activity is an important part of treating many gut maladies, particularly irritable bowel syndrome. In fact, a lack of movement, perhaps because of an injury, can even be the initial trigger for IBS.
“Exercise is part of lifestyle management, which is the first-line treatment for any patient with IBS or other bowel-related issues,” said Dr Anthony Lembo, the research director of the Cleveland Clinic’s Digestive Disease Institute.
What does exercise have to do with a healthy stomach?
Studies have consistently shown that IBS patients who exercise regularly have fewer symptoms than those who don’t. But, while experts agree that mild to moderate exercise is beneficial, the reasons are a bit of a mystery.
IBS is caused by miscommunication between the brain and the gut, which leads to pain and bloating during the normal digestion process. For some people it primarily causes constipation, while others experience mostly diarrhoea or a combination of the two.
The digestive system has a complex network of neurons – sometimes called the “second brain” – that controls blood flow, secretions and hundreds of gut functions through the vagus nerve, which connects the brain to organs in the body. As such, the brain has an outsize influence on the digestive tract, and vice versa.
“The brain and the gut don’t always talk to each other in a way that is suitable for health,” said Dr Maitreyi Kothandaraman, a gastroenterologist at the University of Calgary. The mental health benefits of exercise, she added, “can restore the connection between the brain and the gut and impact IBS.”
Experts have also found that exercise improves the gut microbiome, promoting healthy species of bacteria. For instance, exercising for the recommended two and a half hours per week has been shown to encourage the growth of dozens of healthy bacteria that protect the intestinal wall, decrease inflammation and break down food.
HOW EFFECTIVE IS EXERCISE IN TREATING IBS?
The best use of exercise for IBS, Dr Kothandaraman said, is probably in the prevention of the condition, rather than its treatment. A paper from February, for instance, found that regular vigorous activity was associated with fewer gut problems later on.
But if you already suffer from IBS, regular movement can still make a difference, especially if you are not already working out regularly. Dr Kothandaraman considers exercise the third priority in treatment, after adjusting diet and addressing underlying mental health issues, but before turning to medications.
Experts say that exercise is more likely to be helpful for patients who experience constipation from IBS than for those who experience diarrhoea more often. Put simply, movement begets movement.
However, a recent study in Italy suggested that patients with both forms could benefit, said Dr Andrea Costantino, a gastroenterologist at the Policlinico of Milan and leader of the project, which has not yet been published.
The important thing, he added, is to be patient. Think of exercise like a medication, which may take a couple of weeks to show any benefit.
“Don’t expect that after the first walk or run you will be like, ‘I can’t feel my intestine anymore,’” he said.
WHAT KIND OF EXERCISE IS BEST?
The simplest answer is that you should find workouts that make you feel good and that you are able to stick with.
Most experts suggest starting with light, calming exercises like walking, yoga and tai chi. IBS is more sensitive to stress than just about any other malady in the digestive tract, said Dr David Levinthal, an expert on the brain-gut connection at the University of Pittsburgh Medical Center.
“Time and again, exercises that focus on core muscle – yoga, Pilates – have a calming effect,” he said.
Although most experts said there was little evidence that higher intensity was better, Dr Costantino said moderate exercise, like jogging or other activities that make you out of breath, might offer added benefits. But if you are new to exercise, you should start slow – he suggested two or three 20-minute sessions per week – before trying more.
It’s important to find an activity that’s not prohibitively painful. If you are able to manage your gut discomfort for a few weeks, Dr Costantino said, it’s worth pushing yourself, at least until you know whether it’s helping. But if the pain becomes too strong to continue, it’s better to focus on other management paths, like diet or medication. The experts agreed that some forms of intense exercise, like long-distance running (which can affect digestion), could aggravate your symptoms.
Rather than focusing on how hard you’re working out, aim for consistency and be forgiving of yourself.
“Having rock hard abs doesn’t necessarily translate to better function of everything else that’s in there,” Dr Kothandaraman said.
By Erik Vance © The New York Times Company
The article originally appeared in The New York Times.
