We welcome Dr. Cecilla Minano, a highly experienced gastroenterologist and certified trauma-informed life coach. With over 15 years of practice, Dr. Minano has a passion for helping people with chronic gut issues reclaim control of their lives and find purpose and joy.

Show Notes

Guest: Dr. Cecilla Minano, a gastroenterologist and certified trauma-informed life coach. She's been in practice for over 15 years and has a passion to help people dealing with chronic gut-issues regain control and live a more normal life with purpose and joy. She help clients understand patterns of chronic stress through the lens of the nervous system and help them learn to regulate their nervous system, process feelings and sensations, enhance self-care, and build up new life skills that help them thrive in their day to day interactions and beyond. 

Time Stamps:
0:56 - 03:30 Introduction
03:31 - 09:37 The connection between stress and gut health
09:38 - 17:15  Chronic stress and nervous system
17:16  - 20: 11 Common gut issues that high achieving professionals experience
20: 12 - 24 :36 Can someone with chronic gut issues still live a normal life
24:37 - 27: 36 The importance of trauma-informed care in treating gut issues 
27:37 - 32: 54 Tips on how to manage stress and improve gut health
32:55 - 36:27 Achieving Work-Life Integration and Fulfillment with Gut Issues and Burnout

For more information about today's guest, please visit her website at 
www.ceciliaminanomd.com

Transcript

Welcome to Gut Matters the Science Behind Gastrointestinal Health, a podcast where we explore the world of gut health and learn about the latest research and breakthroughs in treating IBS and other gut conditions. On today's episode, we have a special guest, Dr. Cecilia Minano, a gastroenterologist and certified trauma informed life coach. She's been in prison practice for over 15 years and has a passion to help people dealing with chronic gut issues, regain control and live a more normal life with purpose and joy. She helps clients understand patterns of chronic stress through the lens of the nervous system and help them learn to regulate their nervous system, process feelings and sensations, enhance selfcare, and build up new life skills that help them thrive in their day to day interactions and beyond. So stay tuned to learn more about how to improve your gut health with Dr. Cecilia Minano.

Please introduce yourself and what you do:

"Hi, I'm Dr. Cecilia Minano. I am a gastroenterologist and certified trauma informed life coach. I've been in practice for over 15 years and was dealing with my own burnout story. I found that through COVID I felt like I had lost so much control and that I needed help dealing with my anxiety and stress. And so I reached out for life coaching and it's been truly transformative. So now my passion is to combine my day job, which is a gastroenterologist, and expand upon that to help people, particularly busy professionals dealing with chronic gut issues, to regain some control and live their best, most normal life. I do this through a mind body approach. So with the mind, it's focusing a lot on regulating the nervous system, getting out of that fight or flight response or freeze response, and going into more that calm, rest and digesting. It's also looking at limiting beliefs. For example, the belief that I'm never going to get better or my body is broken. I help clients to open up that space to begin to believe I'm on a healing journey. I'm learning to regulate my nervous system. I'm learning to accept what is and the unknown. It also includes tapping into the wisdom of the body and processing feelings and sensation. A lot of us may not realize it, but we're living in chronic stress. And that that stress is living in our tissues. And so it's really staying present with our own bodies and seeing what's coming up. What does our body need? Right? We want to approach it from a mind and body perspective because there's a strong bidirectional mind gut connection, which I'll discuss in more detail. I want to offer hope to people dealing with chronic gut issues that you can regain control, you can live your best, most normal life."


Can you explain the connection between stress and gut health?

"So there's a strong connection between stress and gut health through what's called the gut brain axis, but I like to explain these in two different ways. So the first one is to really deep dive into stress. So what is stress? It's a physical or emotional tension that is experienced by our body or soma and stress gets a bad rap. But I want to distinguish what's more of an acute stress or for a limited time versus more of a chronic or prolonged stress. So acute stress is when we're releasing that cortisol, those neurotransmitters like epinephrine and norepinephrine, and they're necessary to develop a new skill. As you can imagine, when we're infants and we're learning to crawl or walk, right, there's a lot of missteps and falls and those are necessary stressors on our body so that we can develop a new skill such as crawling or walking. Same thing, for example, when we're going to give a lecture, right? We can feel that stress, which may manifest as like butterflies in our belly, but that's necessary because we're learning to gain confidence, to talk about a topic we studied. And those are good stressors that help us evolve and grow and become the best of ourselves. The issue that when we talk about gut health is more of this chronic and prolonged stress that many of us are under. We may not even realize it, but it was probably like living in our soma for a while and then the pandemic hit and that threw it off the charts. So chronic stress, if you can imagine from a physiological standpoint, it's like where you're constantly in that fight or flight or freeze response, you're releasing all these stress hormones, your body's perceiving that you're being attacked by a lion when it's more of a perceived or like chronic, subconscious, even stress. What I want to offer is that there's a part of our brain called the amygdala, which is that danger detector. And that for people that have had difficult upbringings, insecure, attachment or living in chronic stress, that amygdala is always scanning for the next danger, the next shooter drop. And what's happening is that that is inadvertently sending stress hormones to our gut, which is impeding it from working at its optimal state. So when I talk about the gut health and the gut brain axis, what I want to highlight is that when we're living in these two extreme states of the fight or flight or freeze response, that all these stress hormones and neurotransmitters and signaling pathways are very inhibitory to our gut, right? It's not allowing it to optimally work in digestion, in what we call peristalsis or movement or contractions of our gut signaling pathways that help to keep that gut lining healthy, robust, that allows nutrients to be absorbed, that increases blood flow to our gut. It's all compromised. And numerous studies now show that people with issues like depression and even like neurodegenerative disorders have a less diverse microbiome. And I do think it's bi directional. I think there is some neuro inflammation happening and some of it is created from our microbiome being less diverse. So from the gut perspective. And that microbiome I discussed, that's sort of all the healthy gut flora, right? It's made up of like, bacteria, of yeast, of viruses, and they all, in an optimal world, work together to allow us to digest food, to absorb nutrients. They even have a lot of roles in endocrine immune function. So when our microbiome is in a healthy, robust state, we're sending positive messages to our brain, right? That aka. Leaky gut, where those tight junctions open up and, like, pathogens are getting into our bloodstream. That's not happening when we have a healthy gut lining. But when that's compromised due to a poor diet, antibiotic exposure, chronic stress, then some of these pathogens or microbes are getting into our bloodstream and are affecting our nervous system, particularly through the vagus nerve. The vagus nerve is an important part of our autonomic nervous system, but most of the pathways occur from our body to our brain, I think up to 80%. So it's really important to get a hold of this mind gut connection because when we're living again in this chronically stressed state, we may not even realize it, but we're inhibiting the optimization of digestion, of elimination of nutrient absorption."

How does chronic stress impact the nervous system and gut function?

"I like to teach about the chronic stress impacting the nervous system in a few different ways. So let's talk about our nervous system. So, from an evolutionary standpoint, we first developed what's called the reptilian or primitive brain that's very involved with autonomic functions, right? Like our breathing, our heart rate, our temperature. It evolved about 400 million years ago. We don't even have to think about this part. Next came our limbic system, which came about about 250,000,000 years ago. That's our emotions and memory. And within that is that amygdala that I had discussed previously. Our danger detector in our brain. And it's picking up both perceived and actual stressors that are happening in our environment. And our body doesn't know to distinguish the lion attacking us versus a perceived threat. It's going to immediately put us into that fight or flight or freeze response. The last brain area that developed was called our prefrontal cortex. That came about 500,000 years ago. And that's the part that makes us human. It's that focused attention, ability to plan ahead of time, to have an exercise, good judgment. So from an evolutionary standpoint, I distinguish the primitive brain, which is the reptilian and limbic system, which is very reactive and emotional, versus the prefrontal cortex, which is the part that makes us human, that gives us choice. That's working in our best interest in a calm state. And I equate it almost to like the toddler who's throwing a tantrum and wants, like, chocolate cake for dinner. That's that primitive brain versus the prefrontal cortex, which is the adult that knows in the long run that's not in the best interest of that child. So they calm that child down and say, no, this is what you're going to get fed. We've decided ahead of time that this is a choice and this is what we're eating. The other way I like to teach about the nervous system is through what I call the autonomic nervous system, which is made up of our parasympathetic sympathetic and the interactive nervous system, which is actually our gut system. So particularly with the autonomic nervous system, we have to talk about the vagus nerve. That's called cranial nerve ten. It's also called the wandering nerve. It goes from the back of our brain stem through our whole body down to our pelvis. It has a ventral portion which is involved with social engagement, with swallowing, our voice, our ability to see. And then we have the dorsal part, which is to our heart, our lungs, our whole digestive tract, and even our kidneys. And like I had mentioned before, 80% of these signaling from the vagus nerves goes from our gut or body to our brain. Dr. Porges is a famous psychologist who came up with what is called the polyvagal theory. And the idea is that stressors, either internally or in our environment are creating a lot of signaling to our vagus nerve. And it's either putting us into a safe response, a danger, or life threatening response. So the safety response is where our parasympathetic nervous system is very involved. We're working optimally. We're socially engaged, we're relaxed, we're regulated. We're ready to connect with others. We're deep breathing, communicating, and doing those executive functions. Prefrontal cortex is engaged. When we're in that danger or sympathetic fight or flight response or hyper aroused, blood flow is going to our heart, lungs and muscles to run away. We have faster breathing, and we can quickly go into a panic or rage, blame and judge. The last part is when our nervous system is so overwhelmed, we activate what's called the dorsal vagal pathway. That's when our nervous system can't take on anymore and it goes into an immobilizer survival state. It's called hypo arousal. And within that, we can have a freeze, shut down, collapse, dissociative state, and feelings of shame, hopelessness or overwhelm can take over. This is really important to highlight because from our gut perspective, the only ones that are sending, like, healing and calming rest and digest is when we're in that parasympathetic ventral response. We're sending positive messages to our body to engage more blood flow to our gut, to release more mucus to help with elimination, as well as barrier protection. We're optimizing those digestive juices. We're optimizing elimination. We're optimizing our immune and endocrine function. We're creating a robust microbiome, and we're protecting pathogens from penetrating through those tight junctions of our intestine. This is really important to highlight because if you think about it, if you're chronically stressed, you're not even realizing that you're working against your own body or soma. And the beauty of having this awareness is that you have choice and you can make changes I love to teach people about before they're going to eat, to take three prolonged breaths so that we're re engaging that vagus nerve, right? Let's put to work the nerve that helps us to break down foods and absorb those necessary nutrients. And this is a practice that is free, that we can do at any moment, all in the hopes of helping our own gut symptom."

Can you discuss some common gut issues that high achieving professionals may experience?

"High achieving professionals experience the same common gut issues as everyday Americans, including symptoms such as Bloating irritable bowel syndrome with both mix tools, more loose or constipation reflux abdominal pain. What I want to highlight is that high achieving professionals have certain characteristics which have helped them excel and professionally, right. They tend to be self sacrificing, perfectionists, over workers, and can even be people pleasing putting others first. And what's unique to this group of people is that they've excelled in everything. But then they have this suffering or victim mentality with their gut and they're doing all the things that they perceive within their control, which includes like, eating right for some, exercising. But many of them may not realize that there's this whole stress response and because they've lived in it for so long, they don't even realize it's a problem. So they've neglected themselves so much to achieve this professional pinnacle, but now it's costing them issues with their gut, with their sleep, their overall wellness. So the work I do, particularly with high achieving professionals, is we sort of address some of their belief systems and we tap into the wisdom of their body, of what these sensations might mean. And we help them understand that in addition to doing all these things that are good for their overall well being, one of the big things they have to learn is how to regulate their nervous system, to reengage that vagueness now, to let go of frustrations, of anger. Because at the end of the day, that's only hurting themselves. And what I want to offer is that people can change, it just can take time. It's implementing small new habits that then you build upon. And it's learning to let go of people pleasing behavior, where you're putting work first, your family first, and really honoring what your body needs, right? Because when we can't be our best cells, we're not showing up as our best cells for us."

How can someone with chronic gut issues still live a normal life?

"People with chronic gut issues tend to live in that fight or flight or freeze response because they don't feel well. Their symptoms are overwhelming, they sometimes can't go out, they feel like they don't have any control. So it's not uncommon to live in that space when you don't feel well for some time. But what I want to offer to clients or people suffering from gut issues is that language matters and it's important to change that because subconsciously your nervous system is picking up on these beliefs and firing those stress hormones and those neurotransmitters, right, to escape the threat. And so one of the big things we discuss is acceptance of where you're at. Let's have a less adversarial relationship with our body and how can we nurture it and heal it and send safety messages for ourselves? How can we let go of limiting beliefs such as my body is broken, right? Is it really true? Or are there other parts of your body that do work? And maybe it's not broken, maybe it's on a healing journey, right? Language matters for yourself and for your soul or body and nervous system. And also what is a normal life, right? That's very subjective. We want to fall into these molds that have been given to us, to these belief systems, but sometimes they don't serve us. And it's really tapping into what nourishes, my system, what is good for me, right? Not what does this person expect of me, not what is the story I've been told of what I should be doing. So that's the first step. The next step is I help people to build up a resiliency toolkit. So resiliency is your flexibility or ability to deal with an adversarial event or circumstance or lived experience, right? It's not that we can prevent things from happening to us or what has already happened, but how can we grow from that and learn from it and evolve into our next best version? Or have an upgrade of a 2.0? Within that is something called emotional intelligence, which is being vulnerable and processing emotions that haven't been expressed, right? Sometimes these traumas or emotions are living in our tissues and when we can allow them to come forth, we develop more vulnerability, acceptance, compassion for ourselves. I also teach about connection, right? When we feel isolated, we're inadvertently releasing more stress and how difficult life is. But how can we reconnect with loved ones, with people who we perceive as safety? Or it could even be a pet learning to play again, have joy. What are hobbies or interests of you? Maybe you like to dance, or do yoga or walk in nature. Let's reengage that. And also just movement, right? Numerous studies show that just being outdoors for a little bit, stretching, these are all necessary to create that parasympathetic nervous system back online, right? We're releasing the stressors that can get stuck in our body and discharging it. And finally, I teach about choice and control. When we believe that we're a victim of the circumstances of life, of these symptoms, it can be overwhelming. But within that parameter, where do we have choice? Where can we make a shift? What new habit can we create for ourselves that are empowering uplifting for us?"

Can you talk about the importance of trauma informed care in treating gut issues?

"Being trauma informed is critical in dealing with any chronic illness, particularly gut issues. Before I get into that too much, let's discuss what trauma is. So trauma is an extreme form of chronic stress where you feel like you're fragmented, you've lost choice, you can disconnect from others. It has five ease associated with it. So it's an exposure to an event within our environment and it affects on our body or soma so that's physiological, psychological or emotional and it's then the interpretation of that experience. So what might be traumatic for one person might not be traumatic for another. Right? There's so many characteristics within the person that create that. And one of them is our lived experience of difficult upbringings, of insecure attachment. And I like to highlight the importance of trauma informed care because being even within the medical system can be traumatic for people, right. They're in this perceived victim role when engaging with healthcare workers and going to the emergency room. And that can be very activating for people's nervous system. And what I like to offer is that being traumainformed is where you can recognize when someone is in a very like fight or flight or frozen response and you can then be an agent of change, an agent to calm that nervous system down, right. You can de escalate that situation and extend some compassion and joy, right. Nervous systems pick up on that through again, that amygdala, right? Maybe it can calm down a little. And particularly with people who've had difficult upbringings or trauma, I include myself because I have my own trauma history. We can quickly escalate from that parasympathetic response to that overwhelmed or hypo oral state and that those are very inhibitory to our gut. So by being trauma informed, you recognize and you can help that other nervous system regulate, right? I can pause and breathe with you, teach you a few exercises that enable you to use when you're feeling activated in a future instance, or to even delve deeper into an issue you're bringing to me."

Can you give some tips on how to manage stress and improve gut health?

"I like to preface these tips on how to manage stress with the lens of there's a lot of information out there, but let's try to practice one and see how it lands for you, how well you can adopt it before you try to incorporate so many. Right. Because what I find is that if you try to exercise, sleep better, eat better, it's a lot of new habits to form and it can be overwhelming. And sometimes we can give up easily because we've set the bar so high. So some simple tips. I like to meet the client where they're at and figure out what's the utmost importance to them. But some of the things I love, for example, is the breathing, right? So the breath work can be taken anywhere. It's free. The power of that is that you're engaging that vagus nerve as you take a deep breath, you're pausing you're getting rid of those shallow breaths that are like the fight or flight and really releasing the power of that vagus nerve to calm our nervous system. I love this box breath because it's a simple exercise that I even teach to my children. So that's where you breathe in for four, hold for four, out for four, and then hold for four. And you imagine you're drawing the lines of a box on each of those exercises. The other one is the diaphragmatic breathing. You put one hand on your chest and one on your belly. And the first thing I have clients do is exhale. And as they exhale, they're bringing that belly button toward their back. And as you inhale, instead of moving your hand on your chest, you're going to expand your belly like a balloon, and then you're going to hold it. And as you exhale that, again, bringing that belly button to your back. And the goal is to not move your chest, but just expand your belly. I love to have clients do that, particularly either of those before they're eating, right? Let's put that vagus nerve to work when we need it. I like to talk about what are the pillars of wellness for people. So some of those include movement, which is releasing the stressors that are embedded in our tissues, getting enough sleep, right. We know that to optimize healing, we got to rest, get into that circadian rhythm. Right? Those are all sending healing messages to our body, allowing our body to recover. I love things like journaling, like I said, or connection with others. What is good for your soulmar body? Another big one is that with people pleasing behavior, perfection is how can we release that narrowed focus and expand that a little? How can we create boundaries for ourselves that are in alignment with our healing? Maybe we tell our families, hey, for the next ten minutes, don't bother me, I need to meditate. Or I love this one I used to do after a long day, I would just sit in my car for five minutes and just take some deep breaths, try to focus on gratitude of things that went well for me and that helped me reengage that vagueness nerve. The reframing thoughts is another one, right? If you're going to believe that you're never going to get better, you're subconsciously sending stress hormones to your gut. So how can we learn to believe that? I'm learning to calm my nervous system. I'm learning to take pauses. I'm learning to find foods that nourish me. Those are just some examples. We dive deeper into my courses and my coaching. But these are simple ones that you can adopt again, maybe find one that resonates with you and practice it like a few times a week and see how you can create some success for yourself. I love to give the example of like, with movement, right? How can I incorporate ten minutes of movement in my day, right? Sometimes it's as simple as I'm washing dishes. Let me raise my legs while I'm doing that. Let me do a little dance as I wash it, right? How can you attach a new habit to an already existing habit that you are?"

How can someone with gut issues and burnout achieve work, life integration and personal and professional fulfillment?

"No matter if a person is coming to me with gut issues or burnout issues, a critical piece is this work, life integration and personal professional fulfillment. I love this exercise of what are your priorities? And I like to start with one. Is it a personal or professional? Right. We want to stack upon success so not overwhelm our system. What are your priorities? And let's list them out and how much time you're spending with each of them. And then what do you want to be your life to look like? Right? Do you want to spend more time with family or more time, like, coming after this goal professionally? Do you want to achieve a promotion? Right? Let's see where the disconnect is and how can we integrate them so it looks for what you want. And I offered to clients that were in a season of change and flexibility, right? So just because you were working so hard to achieve this pinnacle, maybe now it's looking a little different. You want to be more with your family at home or just cutting back, right? We can stay stuck in how we've lived and think that that's always the way it has to be, but that's just not true. So, for example, for a client that wanted to begin to move more, what would that look like? Let's define that. What would it be? Is it like walking in the park? Is it going to the gym? Is it yoga? Home on a video? And then, how can we then begin to incorporate that into the schedule? Right? We're trying to create more balance. So where are the gaps in your schedule? And how can we build this up for success? And also knowing that when that time comes, there may be a part of us and a feeling of us of dread? And how do we work through that so that we're still in alignment with that future version of ourselves that wants that goal, right? If we think about it from that nervous system I had discussed earlier, that primitive brain, is that toddler? And they're going to argue with you of why you shouldn't go, you had a hard day. But it's really just recognizing that and saying, okay, that's just my primitive brain, but my prefrontal cortex, the part that's engaged that threshold, that makes decisions, this is an alignment with what we want. So allowing that tantrum to sort of coexist, but still doing the hard work, that's one example, but it's a lot of, like, assessing the priorities for each individual and seeing where we can fill in those gaps and really integrate to the life you want. Let's get out of the subconscious autopilot world and really go after what you wanted to do, what your purpose is. But again, it requires pausing and assessing the current situation."

This podcast is brought to you by Casa De Sante, a virtual GI clinic focused on chronic gut conditions such as IBS and SIBO. For more gut health resources, visit www.casadesante.com and follow us on Facebook and Instagram.