Oh my gut, I can’t handle the stress!

We’re all familiar with the expression “I have a gut-feeling”. Fewer of us either have or will taste the full-on experience in the most literal, gastrointestinal sense. A gut-feeling, by definition, is a premonition of trouble when there’s no physical evidence to suggest it. Likewise, you feel abdominal cramps, flatulence, gases, constipation or diarrhea, but you’re well aware: you’ve been eating healthily and taking all the necessary exercise. In fact, you’ve reached as far as trying everything: doctor-prescribed foods, hydration, your grandma’s magical recipe that cures all illnesses, healing voodoo by a Chinese specialist – your gut persists. Digestive discomfort is never more ‘gut-wrenching’ than when the cause of it is an emotional trigger. Or, in the most common, over-used term, stress.

Why Stress Attacks Your Gut

It might surprise you, but when stress attacks, its primer battle front is the gastrointestinal tract. Why that happens, you ask. To insert some brain science here, 90% of our brain’s function supplements the vagus, or the pneumogastric nerve, which connects the brain stem to your abdomen. Decreased brain activity results in poor vagal activity, which inflicts the intestinal immune system and intestinal blood flow. This favors the growth of yeast and pathogenic bacteria which cause a leaky gut.
This situation is worsened by a fundamental physiologic response that has marked our nature since the primitive years, known as the “fight or flight response”. In the stone ages, this function served as a genetic wisdom implanted into our brains to protect us from the proverbial tusks of a tiger. It pumped adrenaline and other stress hormones through our body in order to prepare us to “fight or flee”. Unfortunately, in today’s modern society, a ‘tiger’ is upon us every 10 minutes. And, in order to defend us, our body shunts blood flow away from our digestive system to propel our muscles and heart. So, our pupils dilate, our heart starts pounding and our hair rise. To produce adrenaline, our body uses energy from the “sugar storage”. As a result, the stress response decreases our gut motility, nutrient absorption, oxygenation and enzymatic output.
But how exactly is our mental health connected with our gut?

The Gut-Brain Connection

Chris Kresser, a globally recognized leader in the field of ancestral health and New York Times best-selling author of the book ‘Your Personal Paleo Code’, says: “They’re not connected, they’re the same system.” According to him, we should treat emotions and physical health in a cyclical rather than a linear fashion. To explain this further, some physicians describe it as having two brains: the central nervous system and the enteric nervous system. Both organs are created out of the same type of tissue.
So, stress causes digestive disorders, which in turn produce stress-inducing neurotransmitters. In addition, the gut bacteria communicate with our brain producing hormones like serotonin, dopamine and GABA. The bacterial ecosystem is also linked with the immune system, which itself impacts mood and behavior. So, not only can you get stomach pain from stress, but you can also grow anxious as a result of a leaky gut. It’s like the egg-chicken case, you can’t determine which one comes first. Once you enter the cycle, you’re in the cycle. This means that, in order to find cure, you need to treat both: not only your digestion, but your brain as well. “You don’t have to figure out which one,” says Kresser. “But you can figure out which one you haven’t been focusing on. And so you might get more mileage by focusing on one area because you’ve been neglecting it.”
Given the gut-brain connection, we can understand a student or athlete that has to run to the bathroom before an exam or a game respectively. We understand why people get butterflies in their stomach and become nauseous before major events in their life. “It is all in your mind”, you’ve probably heard thousands of times. And the truth is, it is. But not in the sense that GI ailments are imagined. It is in your head, because your brain is there, and your brain is involved in the malfunction.
However, the majority of people with gut syndromes don’t visit a doctor saying “my brain hurts.” They say, “I’ve got loose stools” or “my stools are discolored”. They say, “I’ve got gas and bloating” and “I can’t poop normally.”

Symptoms of a Gut-Brain Malfunction

Research has proved that people with GI syndromes have a lower pain threshold than healthy ones. So it’s not about the amount of gas you produce daily, it’s about the pain it afflicts.
Let’s first issue what a healthy digestive tract is, before we move onto the signs of a malfunctioning one. Food takes roughly one day to travel through our body. Once in our stomach, gastric enzymes turn it into paste. After that, it’s sucked into the small intestine, where all significant nutrients are mustered up and sent into the bloodstream. The leftovers move into the colon, where all the remaining liquid gets removed. The detritus then takes from 1 to 4 days to make it to our anus. A healthy bowel movement should be shaped like an “S” or a banana because that’s the shape of your rectum. And, like a banana, it should be about 11/2 inches in diameter.
Anxiety either slows down or speeds up the food tract. Furthermore, it weakens the immune system, leading to bacterial imbalance, and decreases the serotonin levels in the stomach. Serotonin regulates gut motility. Therefore, we have depression paired with constipation. Malfunctioning bacterial process produces smelly and painful gases, and food moving through the intestines at unusual paces results in stool discoloration. Common unhealthy colors are yellow, black, red (which indicates blood) and grayish brown. In addition, you may experience heartburn, rectal bleeding and diarrhea.

A common symptom is also feeling like you “need to go”, only to find out it was a false alarm after you’ve pulled down your pants. This happens because stress builds pressure in our body, making us feel like we’re ready for a bowel movement.
But are all these symptoms related to stress?

To make sure that your GI illness is caused by stress, Harvard Healthbeat has listed these physical symptoms as related to stress:
• stiff or tense muscles
• headaches
• sleep problems
• shakiness or tremors
• recent loss of interest in sex
• weight loss or gain
• restlessness.

And as for emotional signs:

• overwhelming sense of tension or pressure
• trouble relaxing
• nervousness
• quick temper
• depression
• poor concentration
• trouble remembering things
• loss of sense of humor
• indecisiveness.

As written in the Journal of Physiology and Pharmacology:
“Stress, which is defined as an acute threat to homeostasis, shows both short- and long-term effects on the functions of the gastrointestinal tract … The major effects of stress on gut physiology include:
• Alterations in gastrointestinal motility
• Increase in visceral perception
• Changes in gastrointestinal secretion
• Negative effects on regenerative capacity of gastrointestinal mucosa and mucosal blood flow
• Negative effects on intestinal microflora

But we shouldn’t discuss symptoms as a mass of ingredients all boiling in the same cauldron. Stress is associated with numerous GI ailments. Those are: Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Gastroesophageal reflux disease (GERD), peptic ulcer and food allergies. All of these syndromes have different sets of symptoms. In this article, we’ll refer to the two that physicians have mostly related to stress: IBD and IBS.

Inflammatory Bowel Disease

IBD patients suffer from red, swollen and overly painful digestive tracts. This category includes Crohn’s disease and ulcerative colitis. While Crohn’s disease debilitates the tissue lining of the GI tract, ulcerative colitis afflicts the colon and rectum. The impact causes ulcers, bleeding and pus. Symptoms vary among gut pain, fever, rectal bleeding and diarrhea, fatigue, loss of appetite, weight loss, and anemia.
Though it hasn’t been yet confirmed whether psychological stress is the cause for IBD, one thing is for certain: it can worsen the symptoms. In fact, patients that have been clinically diagnosed with Crohn’s disease or ulcerative colitis are strongly advised against stressful life situations, as it might trigger a relapse. At the same time, IBD itself produces stress and then stress aggravates the effects. Cycle, remember?

But how can stress cause a relapse?

As we discussed above, when stress attacks, our body prepares for a fight-or-flight response by producing hormones such as adrenaline, which trigger inflammation. In IBD patients whose symptoms have been dormant, this reaction can awaken the disease.

Irritable Bowel Syndrome

IBS is a lifelong condition that affects the colon. Symptoms are stomach cramps, bloating, gas, diarrhea and constipation and they can occur periodically, lasting from days to months.
Despite long-term studies, it is still unclear which environmental factors and food products lurk behind the development of IBS. It is for this reason doctors and scientists have long researched the role of stress.
There is a complex interaction between stressful live events and IBS. A recent study by the Institute of Internal Medicine at the Catholic University in Rome showed that subjects with IBS had higher levels of anxiety and depression than subjects with lactose intolerance. Other studies supported that, although not all IBS patients have stress issues, the presence or absence of stress influences how they cope with the illness. Another research provided evidence that IBS hosts experience more severe episodes of diarrhea and abdominal pain than those with IBD, despite the fact that the latter may have a larger frequency. IBS symptoms display an increasing appearance in people with panic disorder, generalized anxiety disorder and major depression disorder. All these studies pinpoint that there’s a strong connection between stress and IBS, though the nature of this connection has not yet been uncovered.

How to break the vicious circle of a brain-gut illness

To successfully address gut issues, one needs to consider the role of the brain. Probiotics and healthy nutrition are significant, but it’s not unlikely that you could do all of that properly and still have gut symptoms.
“There are three things the brain needs, essentially. Glucose, oxygen and stimulation,” says Kresser. As far as stimulation is concerned, engaging in brain activities such as making shopping lists, cleaning the house, meditation or cooking can help keep your mind alert even as aging takes its toll. Glucose and oxygen, on the other hand, are supplied into our brain via the bloodstream. So one thing you could do to help fix your gut problems is increase your blood flow towards the brain.
The most effective way to do that is arguably acupuncture. Acupuncture is a treatment based on Chinese medicine and it is basically inserting needles at strategic points in the body. It is considered one of the oldest forms of healing and has existed for centuries. This ancient technique increases blood circulation by dilating the blood vessels. Benefits include waste removal, improved oxygenation and nutrient distribution. For philosophical discussion, the notion at the core of acupuncture is that a type of life force known as qi flows through energy paths in our body. Imbalance to the qi causes diseases. Inserting needles at points along the energy pathways can restore harmony.
Then, there are certain botanicals that can also increase blood circulation to the brain. To list a few: feverfew, ginko and cayenne. To make your brain less susceptible to stress neurotransmitters, a diet rich in omega 3 and omega 6 is recommended. In addition, curcumins like turmeric, skullcap, and green tea extract as well as alpha-lipoic acid and glutathione can also help.
Gut-focused treatment includes the GAPS diet, glycine rich bone broths, probiotics, and prebiotic foods like sweet potatoes, Jerusalem artichokes, as well as botanicals like marshmallow root, slippery elm, chamomile, and Spanish moss. Fermented foods such as organic milk, cucumber and onions are also a rich source of probiotics. “Don’t go out and just buy all this stuff and come home with a shopping bag of supplements,” Kresser advises. “Try to find someone who can help with this and focus your efforts.”
Healing methods include sleep, cognitive therapy and of course, physical activity. Sleeping in complete darkness is essential for the production of the hormone known as melatonin, which counteracts stress-induced injuries in the digestive tract. Furthermore, physical exercise stimulates the release of endorphins which relieve anxiety and improve your mood. Last but not least, cognitive therapy, or psychotherapy, is a treatment based on the belief that people can change how they feel by changing the way they think about things.
However, unless you take drastic measures to manage your stress, a supplement regime and exercise aren’t going to suffice. And we’re not talking about stress reduction. With the standards of today’s lifestyle, it’s hard to eliminate stress without making sacrifices either on the work field or at home. And unfortunately, most of us don’t have the luxury to reduce our income. What you can do, though, is learn to live with your stress.
If you’re like me, you’ve probably already googled “stress management” and filled your arms with a couple of techniques like breathing control, visualization, yoga, meditation, as well as youtube videos with step-to-step relaxation guidance. But true relaxation is a personal business and different for each individual.

The Relaxation Response

Dr. Herbert Benson, founder of Harvard’s Medical Institute, has provided an easy method to unwind in his book, “The Relaxation Response”. The Relaxation Response is the answer to the fight-or-flight response and it basically counteracts the physiological effects of stress. It is a physical state of meditation which engages the parasympathetic nervous system. When we’re deeply relaxed, our body makes biochemical and neurological alterations to soothe our muscles, improve our blood flow and withdraw us to pre-stress levels.
We tend to perceive relaxation as an action of letting go, of turning the switch off. In reality, achieving true relaxation requires skill. In order to unwind, you need to train your mind to focus on a single word, a phrase, a prayer, or your breathing. It is only then your thoughts enter a “psychological flow”, meaning that your brain is deeply engaged and cannot be interrupted by external noise, such as stress. Dr. Benson supports that we should spend some time every day quieting our minds in order to accomplish inner peace.

You can find a step-by-step guide to elicit the Relaxation Response here.

Again, if you’re like me, you probably don’t have the luxury to take two hours out of your daily routine. But relaxation isn’t an activity we should include in our schedules. It is a code through which we should regulate our lives. That means that you must learn to ease your body and mind whenever stressful situations occur. And also, learn to pre-organize. Take a different route to work to avoid stress during traffic hours. If you can’t do that, start earlier from home, listen to music or count to help your brain relax. And if you’re suffering from IBS or IBD, learn in advance where the toilets are located, before you arrange an outing. So that the next time you have a “gut-feeling”, you’ll know what to do.