What Really Causes GERD (Gastroesophageal Reflux Disease) and How Should It Be Treated?

by Ram

Damage by Melina Meza

GERD (gastroesophageal reflux disease) is a digestive disorder characterized by recurrent reflux of acid from the stomach into the esophagus triggering heartburn or acid indigestion. The esophagus is a muscular, tube-like structure that connects the throat to the stomach, which is lined by a moist, pink, gel-like tissue called mucosa. The food that you eat moves from your throat down to the esophagus. Two valve-like muscular structures exist in the esophagus to regulate the flow of the nutrients to the correct destination (from the esophagus to stomach to the small intestine). The upper esophageal sphincter (UES) at the top of the esophagus prevents food and other secretions from entering the windpipe by opening or closing at the appropriate time. The lower esophageal sphincter (LES) present at the esophagus-stomach junction prevents the stomach acids from traveling into the esophagus through its appropriate open-close function. 

Gastroesophageal refers to the stomach and esophagus. Reflux means return or flow back. Thus, gastroesophageal reflux is the reverse flow of stomach acids back up into the esophagus, either due to weakening of the lower esophageal sphincter muscles or due to inappropriate closure of the lower esophageal sphincter valve. Certain foods, fermented or fizz drinks, acidic fruits, cigarette smoke, and chronic stress can all cause the lower esophageal sphincter valve to relax, resulting in acid reflux into the esophagus. If this situation happens as a one-time event or acutely it is termed as a heartburn/acid reflux. If it is long lasting and a more serious form or a chronic issue, it is termed as gastroesophageal reflux disease (GERD).  

The most common symptom of gastroesophageal reflux disease (GERD) is heartburn. If the condition persists, additional symptoms may also appear, including a sour taste in mouth, chest pain, difficulty swallowing, dry cough, sore throat, and spewing of sour solids or liquids. Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. Over-the-counter treatments that may help control heartburn include:

1. Antacids that neutralize stomach acid
2. Acid production blockers, also called as H-2-receptor blockers, which provide longer relief and may decrease acid production from the stomach for up to 12 hours
3. Proton pump inhibitors, which are even stronger than H-2-receptor blockers of acid production

However, prolonged use of any of the above-mentioned medications can produce side effects, such as diarrhea, constipation, fatigue, confusion, or bone loss. If the heartburn and other symptoms don’t improve with lifestyle changes and medications, surgery may be the ultimate option. And while the symptoms of the heartburn may temporarily cease through the use of the above-mentioned medications, blocking the acid production is not a good remedy. There is a reason for the presence of acid in the stomach: it is necessary for proper digestion of food. The enzymes that digest the food completely work efficiently in the acidic environment. It is this combination of the acid and the enzymes in the stomach that facilitate efficient digestion of food to a form that can be easily delivered to the small intestine for further digestion and absorption. While the strength of the stomach acid is strong enough to burn a hole through a piece of wood, the stomach itself is well protected from its own acids. However, unlike the stomach, the esophagus does not possess any protective inner lining, resulting in its damage by the acids that shows up as a burning heartburn. This has been the premise so far. 

But now a new research study is changing this long-held paradigm (see Association of Acute Gastroesophageal Reflux Disease With Esophageal Histologic Changes). According to this new study, the stomach acid backing up into the esophagus does not cause chemical burns and damage to the lining of the esophagus as thought earlier. Instead, the researchers from UT Southwestern-Dallas VA hospital suggest that the damage in patients with GERD actually occurs owing to an inflammatory response prompted by the secretion of inflammatory proteins called cytokines. The research work done in mice demonstrates that it takes several weeks for the stomach acid to initiate any damage in the esophagus. So it is unlikely that acids are the cause of the chemical burn since burns develop immediately. In follow-up studies on humans, the researchers followed 12 patients who suffered from chronic GERD. The patients who were taking proton pump inhibitors to control the acid reflux were asked to stop taking the medication. The researchers thought that GERD might redevelop if the medication were to be stopped, providing an opportunity to observe the early changes of GERD. Nearly all of the patients showed damages to the esophagus after stopping the medications. More importantly, the damages that reoccurred were not consistent with acid-triggered burns. Rather, the changes revealed all the tell-tale signs of an inflammatory response, suggesting that the stomach acid in the esophagus actually triggered a pro-inflammatory response by stimulating the production of small molecules called cytokines that trigger’s the body’s own defense system to go awry (see Chronic Inflammation and Yoga: Combating the Fiery Killer).

So what’s in this for the doctors and pharmacists? Since the study challenges a long-held belief about the role of the acid in damaging the esophagus, it is important for medical personnel to have the correct understanding of the mechanisms underlying GERD in order to facilitate novel GERD in order to facilitate novel GERD treatments. 

And what does it mean for people who have the condition and are desperate to jump off the antacid/PPI bandwagon? Good eating habits and good lifestyle practices that include a regular yoga practice go a long way in strengthening the gut. A balanced yoga practice includes asanas, resting poses, pranayama and meditation, all of which support the best possible digestion via our conscious mind and the autonomic nervous system (see The Digestion System and Yoga). As I mentioned in the beginning, chronic stress—which can over-activate the sympathetic nervous system (your Fight or Flight response)—is the single most common trigger of GERD (Our Hyper-Competitive, Stressful World), so consider meditation and restorative yoga practices when you know you are under lots of stress (see How to Practice If You Have Digestive Problems). All of the above practices together with healthy food choices and timely meals will promote a healthy digestion that is required to maintain a long health-span (Why You Should Care About Your Digestive System). So one alternative to consider working your way to healthy aging is by closely listening to your gut!

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How to Practice If You Have Digestive Problems

by Baxter and Nina

Doctor and Doll by Norman Rockwell*

In general, a balanced practice that includes a well-rounded selection of active poses plus stress management will help keep your digestive system healthy. However, if you are currently having digestive problems or if you’re one of those people who have a sensitive digestive system, you can use the techniques we’re recommending here to improve your digestion.

Before practicing, consider your current condition. If you are presently in good health, we recommend that you practice a well-balanced yoga sequence that includes active poses, (both dynamic and static) and restorative poses or gentle supported inverted poses, along with meditation, breath work, or conscious relaxation. The active poses will provide exercise that is beneficial for your digestive system, supporting good circulation to your digestive organs, strengthening the muscular supports around your digestive organs, and stimulating good elimination. The restorative poses, meditation, breath work, and/or conscious relaxation will allow you to spend more time in the Rest and Digest state, which allows your digestive system to function optimally.

If you’re currently having digestive problems, we recommend that you focus mainly on gentle asana, restorative poses, and conscious relaxation, which will allow you to spend more time in the Rest and Digest state while also reducing overall stress levels that could be contributing to your problems. As you start to return to normal functioning, gradually add in more physical challenges in a step-wise fashion. For standing poses, start with dynamic poses, as they are less demanding than static standing poses, and eventually add in static poses when you’re ready. 

Cautions: Using asana for exercise is not recommended for severe cases of diarrhea or constipation, or if you’re having an acute bout of pain related to your digestive disorder. In these cases, we recommended turning to restorative yoga and stress management. For severe diarrhea in particular, Legs Up the Wall pose with a small support under the hips provides a slight inversion that could slow down diarrhea while shifting you to the Rest and Digest state. For conditions where pressure on your belly is painful, avoid restorative poses, such as supported Child’s pose, that cause abdominal discomfort.

How Often to Practice. If you’re currently having digestive problems, practice five to six days a week, alternating days of gentle asana practice with quiet days of restorative yoga and conscious relaxation. If you’re suffering from chronic stress, however, we recommend including a short stress management session six to seven days a week (see Stress Management below).

What to Practice. We recommend that your sequences include a mix of active asanas and restorative poses, as well conscious relaxation, breath work, or meditation. Depending on the type of digestive problems you have, what you practice for the asana section of your sequence will need to vary quite a bit, as you learn what works for you. However, in general, it’s wise to start with gentler asanas, including gentle reclined and seated poses, chair variations of standing poses, gentle supported inversions, and restorative poses. Gradually add in more challenging poses, including both static and dynamic poses, as you monitor the response of your digestive system to them. 

Static Poses. Focus on static poses that strengthen and stretch your abdominal area to help tone your abdominal muscles that house and support the majority of the organs of digestion, and that can assist in moving material through your system. These include:

• Back-bending poses, such as Warrior 1, Locust, Cobra, Upward-Facing Dog pose and Bridge pose, which all stretch the front of your abdomen and strengthen the back of your torso.
•  Side-bending poses such as Crescent Moon pose, Easy Sitting Side Bend, Triangle pose, and Extended Side Angle pose, which stretch and strengthen the sides of your abdomen.
• Seated and standing forward bends, which apply pressure to your abdominal area, strengthening the front of your abdomen while stretching your back, and may assist in moving material through the system. 
• Seated or reclined twists, which squeeze your abdominal area, stretching your back and strengthening the front of your abdomen, and may assist in moving material through the system.

Dynamic Poses and Flow Sequences. Focus on dynamic poses that fold, stretch and twist your abdominal area to improve blood and lymph circulation, and create a squeeze and release affect on your organs, which may support improved functioning and stimulate good elimination. These include:

• Sun Salutations
• Cat/Cow
• Mountain pose to Arms Overhead pose to Standing Forward bend and back
• Seated twists and side bends done dynamically

Restorative Poses and Conscious Relaxation. We highly recommend practicing restorative poses where your chest is lifted and your belly is very relaxed, such as Reclined Cobbler’s pose, because these may bring you quick relief. In addition, if you have sluggish digestion or elimination, we recommend practicing Child’s pose with a bolster to see if that helps. If you have a condition that is worsened by anxiety or stress, we recommend practicing conscious relaxation in Savasana with support for your chest, and bring your mental focus to your abdomen, simply noticing any sensations that arise. 

Stress Management. One of the most effective ways to influence your digestive system over time is to practice stress management techniques—including meditation, pranayama, restorative yoga, and conscious relaxation—as often as you can manage, every day, if possible. Reducing stress levels improves the functioning of your digestive system. It also helps reduce stress eating. While we can’t say that any of the stress management techniques are better than others, you may find that one or two work best for you. So, if possible, practice all of them periodically to be familiar with all of them. You can practice any of these stress management techniques as a part of your regular asana practice or on their own, at a different time of day. See Stress Management Techniques for When You're Stressed.

Meditation. While meditation is an effective way to spend time in the Rest and Digest state and therefore support your digestive system, a regular meditation practice can also improve your digestion by allowing you through mindfulness to learn about eating habits that may be contributing to your problems and by fostering will power to change them. If you are concerned about using your practice to learn about the effects of various foods on your digestive system, use meditation practices that focus on your physical sensations, such as your breath or even the sensations that are arising in your abdominal area. For improving willpower with meditation as a way of changing unhealthy eating habits, any meditation technique will do. See Yoga Meditation Techniques. 

Sleep. If you are having ongoing sleep problems, focus your practice on improving the quality of your sleep, as it will greatly benefit your digestive system by providing a prolonged rest for your entire system, during which you spend time in the Rest and Digest state. See 5 Tips for Better Sleep for recommendations.

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Why You Should Care About Your Digestive System

by Baxter and Nina

Chocolate Kouign Amann by Rosie Gibson

At a very primary level, your digestive system is essential for maintaining your health. After those first gasps of air and the initial cry of a newborn, the first action of a new life is to feed! And a digestive system in decline can be one of the first signs of serious illness or advanced age. The digestive system provides the following four basic functions:

1. Ingestion. Using your mouth to take in foods and fluids, chewing the food, and then swallowing both chewed foods and fluids.
2. Digestion. Breaking down what you eat and drink into smaller and smaller particles, which can then be absorbed into our blood. Anything that can’t be absorbed is passed on for elimination.
3. Absorption. The process of passing the small particles of digested food from the digestive tract into your blood stream, where they can be delivered for fuel to your 70 trillion cells by the circulatory system.
4. Elimination. Removing leftovers of the digestive process that you cannot use from your body. 

These four functions are the how your digestive system provides you with the fuel your body needs to function every day as well as to create the building blocks needed for to growth and repair. And this is also how your digestive system removes waste from your body, a process that is as necessary for your health as ingesting and digesting your food. 

In general, staying physically active, eating a healthy diet and taking in adequate liquids, resting after meals if you can and sleeping well, and good oral care helps you maintain the health of your digestive system. However, one of the most important things you can do to keep your digestive system functioning optimally is to keep your stress levels in check, as stress can have a huge impact on your digestion. (Nina can testify to this, because when she's very stressed out, she literally becomes so nauseated that she can't even eat at all!)

Now let’s take a look at the actual components of your digestive system and the related systems, and the effect that stress can have on them.

Mouth, Tongue, Teeth and Pharynx. Digestion begins as you take food and drink into your mouth and start to break down the food into smaller bits by chewing it and mixing it with your saliva, which contains digestive enzymes. In some people, acute stress can temporarily turn off the production of saliva, negatively affecting your initial breakdown of food.

Esophagus. This tube that runs from the back of your throat to your stomach sack moves your partially mixed food and water to your stomach. In some people, stress can interfere with the smooth muscle rhythm that moves food to the stomach, creating difficulty in swallowing. 

Stomach. Continues digestion by releasing stomach acids and enzymes, and by churning the stomach contents to further break down solids and liquids. In some people, stress can negatively affect digestion by contributing to minor digestive problems, such as heartburn and nausea, as well as more serious problems, such as acid reflux and ulcers. 

Small Intestines. After the stomach finishes its work, the small intestines (a 15-17 feet long tube) use more digestive enzymes to break down the food into even smaller particles of sugars, fats and proteins, which near the end of the tube are then absorbed into your bloodstream. In some people, stress can interfere with smooth movement of food downstream and/or with healthy absorption of food into the circulatory system. 

Large Intestines. After the food particles are absorbed, the large intestines (the final 4-5 feet of tubing that follows after the small intestines), allow most of the remaining water content for our food and fluid intake as well as vitamins and salts to be absorbed into our bloodstream. The waste that remains is collected here and then expelled through your rectum and anus in the form of a bowel movement. Your large intestines are also where much of your gut microbiome lives (see below). In some people, stress can affect the performance of the large intestines, resulting in constipation or diarrhea. 

Liver. Although it has many other functions, the liver aids digestion by producing bile salts, which assist in the breakdown of fatty foods. In some people, stress can produce inflammation in the liver that could contribute to the development of serious liver diseases such as cirrhosis, which will ultimately affect digestion (and cause other serious problems).

Gallbladder. Stores the bile salts made by the liver and releases some into the small intestines when fatty foods are detected. In some people, stress can inhibit the normal release of bile from the gallbladder into the small intestines, which will negatively impact your ability to digest fats appropriately. 

Pancreas. Although it has other functions, the pancreas aids digestion through the production and release of digestive enzymes into the small intestines. In some people, chronic stress makes the pancreas more susceptible to diseases, such as pancreatitis, which will negatively affect its ability to produce digestive enzymes.

Gut Microbiome. The community of microorganisms living in our large intestines and elsewhere in our digestive system make up our gut microbiome. Our gut microbiome has a variety of functions, including the metabolism of certain nutrients in our food, the regulation of our immune system, and modulating various behaviors such as hunger, satiety, and sleep. Maintaining a large variety of the organisms in our gut microbiome is important for the health of our digestive and immune systems as well as for the other systems that interact or communicate with our digestive system, such as the central nervous system. In some people, stress can negatively affect the diversity of the gut microbiome, which has a negative impact on our digestion and overall health.

Enteric Nervous System. A semi-independent web of nerves, the enteric nervous system, sometimes called the gut brain, helps coordinate some of the digestive processes that takes place from the stomach to the beginning of the large intestines, and also signals the brain information that results in feelings of hunger and satiety, whether or not you’re experiencing stress, and if you’ve ingested a disease-causing microbe. 

In some people, stress can interfere with normal signaling of the enteric nervous system contributing to gut symptoms such as cramping and bloating, or causing confused signaling of hunger after stress events that leads to stress eating.

Central Nervous System. To help coordinate your digestive processes your brain is in constant two-way communication with your digestive system though your autonomic nervous system and your hormones. Because of this two-way communication, the health of the central nervous influences the health of the digestive system, and the health of the digestive system influences the central nervous system.

And your state of mind has a profound effect on your digestion. When you are in a state of acute stress, your brain shuts down your digestive system temporarily until the emergency has passed. And when stress is chronic and ongoing, your digestion is compromised because your digestive system isn’t functioning optimally. 

On the other hand, when you’re relaxed and in the Rest and Digest state, your brain turns on the digestive functions that were offline while you were stressed, and is able to work in greater harmony with other systems that support good digestion.

Circulatory System. Delivers absorbed food particles to all the cells, structures and organs of your body, including your digestive system organs themselves by the circulatory system. Water not needed for body functions eventually gets delivered to your kidneys for elimination. In some people, stress can disrupt the normal blood flow to the digestive system, especially to the small intestine, which can compromise the absorption of food into your body. 

Immune System. Along the route of the digestive system are immune functions that are an integral part of the immune system. Examples include:

• salivary enzymes in the mouth, which can kill some organisms that come in with our food
• acidic fluid of the stomach sack, which can kill some invading organisms
• Peyer’s patches, special groups of immune cells that line the inside of small intestines, which can detect and start to fight invaders that make it past the mouth and stomach
• gut microbiome, which may help our immune system adapt more quickly to new infections in the gut

So maintaining the health of your digestive system will aid the functioning of your immune system, just as maintaining the health of your immune system will aid the functioning of your digestive system by keeping your digestive system healthy (see Techniques for Supporting Your Immune System with Yoga).

Because of the importance of your digestive system to the health of your entire body, maintaining healthy digestion is an integral aspect of healthy aging. In general, a well-rounded yoga practice will allow you do this by providing the exercise and stress management—especially stress management!—that you need to keep your digestive system functioning optimally. But if you are experiencing digestive problems, you can target your yoga practice to improve your digestion (see How Yoga Helps Your Digestive System).

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Yoga for Healthy Eating: An Overview

by Nina

Both Baxter and I have already written a number of posts exploring the topic of Yoga for Healthy Eating. But seeing that it’s the beginning of a new year—when people often make resolutions regarding their health—I thought now would be a good time to provide an overview of the topic. Basically, between the two of us, we’ve come up with a four-pronged approach to support healthy eating:

• Understand your digestive system

• Practice stress management
• Cultivate mindfulness
• Strengthen Will Power

1. Understanding Your Digestive System

Baxter has recorded a short audio tour of the digestive system (see Audio Tracks) that you can use to learn about how your digestive system works and what happens to your food as and after you eat it. It’s especially helpful for you to learn about how your digestive system interacts with your Autonomic Nervous System and higher brain function. When you’re in a state of stress (see Stress, Your Health and Yoga), your nervous system diverts your body’s resources away from your digestive system (you don’t need to be eating or digesting your food when you’re running away from that tiger or that car that looks like it’s not going to be stopping before the crosswalk!). So chronic stress can cause digestive problems. In addition, even thinking about stressful situation can have a potential negative impact on digestion!

2. Practicing Stress Management

Chronic stress may not only cause digestive problems as I mentioned above, but the cortisol that is released can cause weight gain by stimulating your appetite (Yoga, Stress and Weight Management). So one of the most important things you can do to improve digestion and move toward healthy eating is to use your yoga practice to reduce your stress levels. See The Relaxation Response and Yoga for basic information on using yoga to switch your nervous system from the Fight or Flight response (stress mode) to the Rest and Digest response (relaxation mode). It’s not called the Rest and Digest mode for nothing!

3. Cultivating Mindfulness

Many poor eating habits are just that—habits! Practicing yoga asana with mindfulness and meditating will help you tune into your body, and not to ignore it. And as you tune into your body, you may learn about foods you are currently eating that are compromising your health (see Got Mindfulness?) or notice poor eating habits, such as eating beyond satiety (see Meditation and Healthy Eating). Cultivating mindfulness can teach you to recognize:

• which foods are good for you and which are not (not just junk food, but maybe food intolerances or allergies)
• when you are full and don’t need to eat more
• when you are thirsty instead of hungry
• when you are eating for stress, not for hunger

See Yoga for Healthy Eating for more information.

Mindfulness will also help you start to recognize habitual thoughts that are getting in the way of healthy eating. You can then work on changing your perspective (see Cultivating the Opposite).


4. Strengthening Will Power

Once you’ve identified your habits or have decide to eliminate or cut back certain foods, it takes will power to change! According the Dr. Kelly McGonigal, being in a state of stress can increase impulsive behavior and decrease will power. So practicing stress management as we describe above will help with your will power (see Healthy Eating, Stress and Self Control). However, you can also use a meditation practice to intentionally strengthen your will power.  Meditation teaches you to return to your object of meditation (your focus) and tune out distractions (temptations):

“Neuroscientists have discovered that when you ask the brain to meditate, it gets better not just at meditating, but at a wide range of self-control skills, including attention, focus, stress management, impulse control, and self awareness. People who meditate regularly aren’t just better at these things. Over time, their brains become finely tuned willpower machines. Regular meditators have more gray matter in the prefrontal cortex, as well as regions of the brain that support self-awareness." —Dr. Kelly McGonigal

See Meditation and Healthy Eating for more information.

Tune in tomorrow to hear from Baxter on the same topic! He’ll discuss stress eating and recommend some specific yoga practices for you to support your goals for healthy eating. 

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Available on Video: Yoga for Healthy Digestion Practices!

by Baxter

Since I last wrote on subject of yoga and your digestive system (see Irritable Bowel Syndrome and Yoga), I completed two live one-hour lectures on the topic for YogaU Online, which are now archived and available on their website if you had hoped to join me live but could not. See yogauonline.com to access these lecture.

And, in addition to the information-packed talks, I completed a one-hour video practice on Yoga for Healthy Digestion in August! It is part of the package you get if you purchase the sessions from YogaU, and it is the first significant video practice I’ve produced in a long time, so I am pretty pleased to have it to share with you! To give you a sense of how I came up with the practices on the video, I wanted to share a bit about how yoga is applied to imbalances in the digestive system.

As I discuss in my talks on yoga and the digestive system, when you have an imbalance in your digestive system, it can often be classified in one of two ways: either a condition of excess digestive energy, such as with heartburn or reflux disease or a condition of deficient digestive energy, such as with chronic constipation. This way of looking at digestive imbalances comes from the work of TKV Desikachar, which I was exposed to back in 2005 when I studied at his center in India. Addressing these imbalances can then be done by applying a particular yogic quality to the practice you design to bring the situation in to better balance, towards homeostasis. 

If a condition is one of excess energy, you’d address it with a calming, cooling, restorative approach. The word we use in the world of yoga therapeutics to describe this is Langhana. On the other hand, if the condition is one of deficiency, you’d address it with a more stimulating, active or heating practice, known as a Brahmana practice. There is a slight paradox here however, for if your deficient condition is really causing you to be depleted, you can always start with a more Langhana style approach, and as your energetic reserves improve, switch to a more Brahmana style practice.  So, you can never go wrong going with the quieter, calming, gently grounding yoga practices, which include gentle asana, restoratives, pranayama (such as a 1:2 ratio inhale:exhale breathing), and guided meditations, to name a few of the Langhana tools.

In the video, you will get a 30-minute practice that exemplifies Langhana practice for conditions of excess and another 30-minute practice that exemplifies a Brahmana practice or conditions of deficiency. I hope you find both the talks and the video helpful as you attempt to get your digestion into optimum balance! You can find them both at yogauonline.com.

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Yoga and Healthy Eating: How Yoga Helps You Tune in to the Effects of Your Dietary Choices

by Baxter

Fresh Bread and Fresh Butter
made and photographed by
Rosie Gibson

It is always a bit bittersweet for me come mid-July when I return from my annual yoga retreat at the Feathered Pipe Ranch  in Helena, Montana. It is a magical place for my students, and me, and most of our every-day needs are met by the staff at the Ranch, freeing us up to dive deep into the yoga and community. 

At this year’s retreat, I focused on many of the concepts we talk about here at Yoga For Healthy Aging, including therapeutic sessions on topics ranging from arthritis to digestion. One of the lovely things about going on these sorts of retreats is that all of your meals are prepared for you, and all you have to do is show up for meal times. The Ranch is no different, and they pride themselves of the variety of healthy, mostly organic foods that they prepare for us each year, from Indian to Thai to Mexican, to the “Toledo Lunch” (a throwback to my childhood favorite, grilled cheese sandwiches and tomato soup). In addition, they always have tempting desserts, from fruit cobbler to fresh baked cookies and cakes to something outrageous called Chocolate Decadence! The downside to this, at least from my perspective, is that the food is served buffet style, so there is the daily opportunity to overeat, despite the overall healthy options provided (minus some of the desserts, of course!)

I have to remind myself to be more mindful about my eating when at the Ranch. It is very easy to make a second trip up for some more of my favorite things, even when my first plate of food was more than sufficient to satisfy my hunger. Satiety is different than eating until I feel “stuffed.” which unfortunately happened a few times last week. But because I was also on retreat in my own way, even though I was teaching twice each day, I was able to have the time to meditate consistently first thing in the morning for about 15 minutes. I found that as I sat quietly focused on my breath or simple mantra (see How to Start a Meditation Practice), I became acutely aware of how my body was feeling and responding to the previous day's food choices. I also would recall if I woke in the middle of the night with indigestion, gas, bad dreams, or the urgent need to use the bathroom. This feedback allowed me to more consciously set an intention around my food choices for the rest of the day.

Since I tend to desire more processed sugar than is healthy for me, (is it really healthy for anyone?), I began to modify my breakfasts, the only meal I prepared for myself in the little teacher’s cabin kitchen, leaving out the jam on my toast and adding in a piece of fresh fruit to satisfy that sweet taste desire that I have. And I began to notice that my energy levels were higher for the rest of the morning as the week progressed. Quite motivating! I have to admit that dessert time was still a tough one, but was at least more mindfully dished and consumed than earlier in the week. 

Surprisingly, I realized I was looking forward to being back in my own kitchen where I could more easily design my meals for not just quality, but also quantity.  All these insights about behavior changes and choices arose directly out of the introspective practices of yoga, like simple breath awareness. They were there for me, and they are available for you, too. As we keep reminding you, consistent practice is a key feature of transformational practice. I did my meditation first thing today again, and my continued healthy, well-proportioned meals choices are reflecting it!

I've been thinking a lot about healthy eating and healthy digestion because my two-part online course at Yoga U is coming up soon. To sign up for the course, you can register here. For a free audio interview with me on yoga for healthy digestion, download the interview here.

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Digestive Health: Online Course and Free Interview with Baxter Bell!

by Nina

In his recent post Irritable Bowel Syndrome and Yoga, Baxter mentioned that he’s going to giving a two-part online course on Yoga for Digestive Health via Yoga U. It’s coming up soon, everyone! And it’s going to be good. (I know because—ssshh!—I’m helping with the presentation.) Here’s the course description:

Learn about the digestive system and how you can use yoga to improve digestive health. In this 2-part online yoga course, Baxter Bell, MD offers an overview of the organs of digestion, their basic functions and how you can use yoga to impact digestive health, from his experience as a western trained doctor and a certified yoga instructor. Dr. Bell will discuss the common digestive disorders and the early signs of digestive disturbances.

To take this online course, you’ll need to register (and pay) here. But Baxter has also done a special interview on digestion for Yoga U interview and this is completely free. Here’s a description of the interview:

In it, Dr. Bell discusses how the digestive system interfaces with other body systems, particularly – the immune system and the nervous system. The digestive system has a separate network of nerves called the enteric nervous system, which works independently of the central nervous system and the brain. Early research even suggests that the digestive system could even impact our mental, emotional, overall well-being.

Dr. Bell further discusses some of the common early warning signs of digestive disorders to be on the lookout for, and how to check whether your digestive function is normal. He also offers insights into the different ways in which our yoga asana practice can have an impact on digestive health, and which groups of postures are particularly important.

To download the interview with Baxter, go here. For those of you who can't practice in person with Baxter, this will give you a little taste of what his workshops are like.

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In Gratitude or With Thanksgiving…Stress and Digestion

by Baxter

Next Thursday is the official kick-off of the holiday season in the US, or maybe more appropriately the Feasting Season, or perhaps the Excessive Cream Cheese season.  Whatever you refer to the next seven weeks as, eating is center stage, and most often, with abundant quantities of food.  And although gratitude and togetherness and love and joy are also the focus of our gatherings and feasts, which seem like lovely qualities and potentially beneficial, we can still experience an increase in overall stress this time of year. And an increased perception of “stress” can have a noticeably negative impact on your digestion. 

When we are in good balance on a holistic level, which would include physical, mental and emotional balance, our digestive system, at least theoretically, should reflect that balance as well. The digestive system has it’s own nervous system, sometimes called the gut brain, known as the enteric nervous system, which can influence the function of the gut from the stomach all the way to parts of the large intestines. Without any direct input from the brain and the spinal cord, the enteric nervous system can move food along and continue with the digestion and absorption of fuel from our food. 

However, there is also interplay between the conscious parts of our brain, as well as the background operating system of the body known as the Autonomic Nervous System (ANS) on our digestion as well. When we are in balance, the Parasympathetic portion (PNS) of the Autonomic Nervous System, prophetically known as the Rest and Digestion system, supports good digestion. However, when you are under stress, whether via truly threatening situations or everyday worries and anxieties, the other half of the Autonomic Nervous System, the Sympathetic Nervous System, dubbed the Fight, Flight or Freeze system, exerts dominance over your enteric brain. The result is a negative effect on the movement of food through the gut, a decrease in the blood sent to the gut for digestive purposes, which inhibits absorption of nutrients out of the gut, while acidity may simultaneously build up in your stomach, increasing the likelihood of indigestion and heartburn.

With ongoing stress, some people begin to crave complex carbohydrates (none of those around for the holidays, right?) as they can trigger the release of calming substances in the brain, at least for short periods of time. The unwanted side effect of such shifts in eating habits is sometimes weight gain.

By activating the Rest and Digest part of your Autonomic Nervous System via yoga asana and other yoga tools, you can guide yourself back into better balance and improve your digestion and decrease those unwanted symptoms like heartburn and bloating. In the spirit of gratitude for your readership this past year, we want to once again share with you one of my favorite poses to do just that: Reclining Cobbler’s Pose. A few months ago, we posted this short video on youtube, which we link to here again with the hopes you’ll watch and try it. It is a reminder to slow down, do some yoga and take good care of yourselves and your digestion this holiday season. I look forward to checking in with you after our break for the Thanksgiving week!

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Healthy Eating and Your Digestive System

by Baxter

I recently heard from a colleague of mine in Portland, Vilma Z, who has hosted me at her lovely studio The Yoga Project in the Sellwood neighborhood over the years.  She was very excited and proud to let me know about a new project she had just completed, a calendar featuring the students from her highly popular class “Yoga for Larger Women.” Vilma has been working with larger women in Portland now for several years, and her experiences and the experiences of her students can be found on the website yogaforthelargerwoman.com. Please go there and read for yourself the amazing transformations these students describe.

Janet from the Yoga for Larger Women Calender

And then this past weekend, I once again offered my workshop on Yoga and the Digestive System.  As part of that course, during Savasana, I guide the students through a journey of their digestive system for start to finish. The last time I taught this guided visualization, several students asked if I had it recorded so they could do the journey again on their own. So, this weekend, honoring that request, I recorded the Journey Through Your Digestive System, and it is now available on Bandcamp at yogaforhealthyaging.bandcamp.com, where you can play it at any time or download it in any number of formats.



I’ve decided to share this recording with you today as part of our series exploring Yoga for Healthy Eating. You might ask yourself the question, “What does having a better understanding of my digestive system have to do with helping me foster healthy eating habits?” Well, one of Vilma’s students, Janet Wieneke, has this to say, which I think has great bearing on this question:

“Around the same time, the thought hit me that I had been dragging this body around for all these past 50 years instead of really living in it.   It came to me that I had not claimed this body, not moved into this body. I was renting it, but I didn’t live there. I didn’t want to live there—in the “undesirable” section of town.

That began to change though when I realized no amount of wishing, bargaining or promising will change the fact that this is my body and that it benefits me greatly to “step up” and partner with my abilities, instead of wishing that things were different.”

So the aspect of healthy eating that has to do with understanding your digestive system is learning to really live in and feel your body, noticing how different foods and meal sizes make you feel, and so on, instead of just wishing things were different. The more in tune you become with how your ingestion and digestion of food makes you feel, the more likely you are to make better decisions in the future regarding healthy eating.

And if you want to support Vilma’s work with larger women in Portland, buy a 2013 Calendar here . The photos—and the women—are lovely! And if you want to support our ongoing work here at Yoga For Healthy Aging, consider purchasing your audio track of the digestive journey from Bandcamp. And let us know how you liked the tour!

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Featured Sequence: Mini Restorative Practice for Digestion (or just relaxation)

by Baxter and Nina

Baxter’s been thinking a lot about digestion lately because he’s going to be teaching a workshop on yoga for digestion this Saturday, June 2, at Fourth Street Yoga in Berkeley, CA (see 4th Street Yoga for details). And he’s observed that a lovely underlying principle for working with digestive issues is that no matter what’s going on, all digestive issues respond to restorative poses. Remember, the opposite of the Fight, Flight or Freeze response is the Rest and Digest response (also known as the Relaxation response—see Relaxation Reponse and Yoga for information). So with that in mind, today we’re presenting a mini restorative practice consisting of three of Baxter’s favorite restorative poses, which you can use to help with digestive problems as well as other problems caused by stress, such as insomnia, fatigue, and anxiety.

1.    Reclined Cobbler’s Pose, from 10 to 20 minutes. Set a timer so you don’t fall asleep in the pose.

You will notice from the photograph that we’re using quite a few official yoga props (including a block under the bolster to prop the bolster at an angle). Don’t let this prevent you from trying it! If you don't have bolsters and blocks, look around your house to see what else you can use; try cushions from your couch, folded blankets, beach towels, and so on. Just make sure you’re completely physically comfortable in the pose.

One of the important parts of completing digestion is good elimination. In addition to physical relaxation, which this pose provides, gravity is also helpful for good elimination. As you can see from the photo, Reclined Cobbler’s pose creates a gradual slope from your head to your hips. Therefore, it’s possible that this pose can help with problems such as constipation and sluggish elimination. One of our favorite teachers, Patricia Walden, suggests that this pose may increase blood flow to your organs, as well as cool your digestive fire.

2.    Supported Child’s Pose, for 3 to 5 minutes. Turn your head to the other side when you’re half way through.

Make sure your bolster (or folded blankets, stacked pillows or couch cushion) is pulled in against your pubic bone so your belly actually rests on the prop. If necessary, turn the bolster on its edge or add folded blankets on top of the bolster to make sure your belly is fully supported.

As you can see from the photo, Child’s pose is a forward bend of your belly toward your thighs. Because the bolster is pressing against your belly, it’s possible this posture will have a stimulating effect on your digestive system and your abdominal organs. Patricia Walden suggests that this pose can relieve constipation, gas, and bloating.

3.    Legs Up the Wall pose, from 10 to 15 minutes. Come out if your legs fall asleep.

We’re showing two versions of the pose, one with just a folded blanket and the other using a bolster with a folded blanket underneath it and a second folded blanket under the spine. Try both versions to see which one is more comfortable for you. If they are equally comfortable, try the higher version, as this may enhance your relaxation.

This pose is a slight inversion (more so on the bolster than on the blanket). Therefore, it could have any even more profound quieting effect on your nervous system than the first two poses. Also because your hips are higher than your heart, there is a mild reversal of the effects of gravity, which could quiet an over-stimulated system in people who have, for example, IBS or chronic diarrhea. Patricia Walden says this is an excellent pose of nausea and diarrhea. However, if you have a history of gerd or chronic heartburn, take care with this pose, and come out if makes your symptoms worse.

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The Digestion System and Yoga

by Baxter 

Over the last 2 years, I have had the good fortune to act as faculty for the Niroga Institute’s Yoga Therapy Program in Berkeley, CA. As part of my teaching duties, I was asked to present and teach the group about yoga and the digestive system. This is a fairly daunting task, as the digestive system is a complex system that interconnects with our conscious mind, the unconscious portions of our nervous system via the autonomic systems sympathetic and parasympathetic systems (which we have discussed here on more than one occasion), and our immune and endocrine systems. Despite the enormity of the task, I came to be reminded of a wonderful fact about the digestive system: it has its own nervous system, called the enteric nervous system (ENS). Upon further investigation, I discovered that this system has a lot to do with helping to move food through the small and large intestines, affecting the fluid absorption from the gut, as well as local blood flow in the gut. The ENS is sometimes referred to as an independent gut brain, which seems quite cool. But this is not quite accurate, for while it does have an independent influence on the many gut activities, it interfaces profoundly with the autonomic nervous system and conscious mind as well.

Human Digestive System

In some ways, this is good news. As we have seen before when discussing yoga and stress, if we can influence the autonomic nervous system and shift the patterns of excess sympathetic stimulation to balanced stimulation, including appropriate amounts of parasympathetic stimulation, we can allow for the body to have adequate amounts of rest and replenishment. In fact one lay term for the parasympathetic system is the “rest and digest response!"

When we engage in a balanced yoga practice that includes active poses, resting poses, breath awareness and relaxation, an interesting thing happens: our digestive system often works more efficiently with less unwelcome symptoms (I’ll leave that to your own experience and imagination to figure out what those are!). So, although the digestive system itself is complex, our yoga practices quite elegantly can interface and support the best possible digestion, via our effect on the conscious mind and the background autonomic nervous system.

More specifically, consider restorative practices and yoga nidra when you know you are under lots of stress that could over-activate your sympathetic nervous system (your fight or flight response). If you’re in the Bay Area and would like to learn more about yoga and the digestive system, consider joining me on June 2nd at 4th Street Yoga in Berkeley, CA. See http://www.4thstreetyoga.com/workshops.html for information. 

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