Stress is obviously unavoidable for most of us and for so many of my clients, a long period of chronic stress preceded their gut health or autoimmune issues. So in case you’re underplaying the importance of stress in your digestive health, I’m going to help you understand why it’s so important, and how to address it so that maybe you can start to tackle the problem and remove the root cause of your gastrointestinal problems.
So just to give one super concrete example of what a brief exposure to stress does, think about how you get nervous before public speaking or a sporting event or a blind date or whatever it is that makes your nervous. What happens? Your body immediately starts dumping serotonin into your gut, which, in addition to being your feel-good neurotransmitter, is also what prompts peristalsis, or the movement of food through your intestines, and all of sudden you have to run to the bathroom with diarrhea. This can happen with a super brief exposure to something stressful. I give that common example that we’ve all experienced to demonstrate how our bodies are such finely tuned instruments that with every thought send chemical messengers or neurotransmitters throughout our bodies, causing seen and felt and also unseen and unfelt (or at least in the short-term term unseen and unfelt) reactions.
Now let’s look at what happens to the gut during a period of acute stress, or strong and immediate but short-term stress. This might be something like almost getting hit in traffic, public speaking, having to meet a deadline at work or having an argument with your spouse. Your body will go into sympathetic or fight or flight mode.
Some people have gut symptoms during these events, like nausea or diarrhea, which is from that sudden release of serotonin, or if you eat during or after one of these periods you may experience heartburn or acid reflux. To avoid some of these unpleasant gut symptoms when you’re experiencing acute stress, avoid eating or drinking and allow enough time to calm down before eating a meal. I recommend taking several 5-5-7 breaths before starting to eat to trick your system into a parasympathetic, or rest and digest, state. This is inhale for 5, hold for 5, exhale for 7.
How does chronic stress impact digestion?
Now chronic stress, on the other hand, is longer-term, lower-level stress, like work pressures, ongoing relationship issues or caring for an aging or dying parent. This kind of stress can, over time, have significant effects on the gut and digestion. If you have chronic stress, you might find that you develop regular and unpleasant digestive symptoms, even when you are removed from immediate stressors while eating. Some of these symptoms include nausea, heartburn, acid reflux, bloating, pain and even vomiting during periods of severe stress. Chronic stress can also change how quickly food moves through the digestive system, causing either diarrhea or constipation. It can also cause muscle spasms, including in the digestive tract, which can be uncomfortable or even painful.
So what are the mechanisms behind all of this? How is it that the brain and gut are interacting, and what can you do about it? The gut-brain axis is how the brain and your gut communicate, which happens via the vagus nerve and the microbes in your gut. The interesting thing about the axis is it goes both ways, meaning the brain can contribute to gut symptoms and the gut can impact brain function.
When you’re under stress, your body releases the hormone adrenaline, and I’m sure you’re all familiar with what a rush of adrenaline feels like. Adrenaline is also known as epinephrine. Your body also releases noradrenaline while under stress, also known as norepinephrine. Together they increase your heart rate and blood pressure and release glucose into the bloodstream to give you energy and then norepinephrine also helps break down fat to give you more energy. So epinephrine and norepinephrine, along with the neurotransmitter dopamine are known as the catecholamines. And what’s important to know about them is that you need tyrosine, an amino acid, to make all of them. The order of operations is tyrosine turns into both thyroid hormones and DOPA, then DOPA turns into dopamine, the neurotransmitter that gives you pleasure, motivation and focus, and dopamine turns into norepinephrine, which turns into epinephrine. So if you’re under chronic stress and over time producing a lot of these catecholamines, you’re using up a lot of your tyrosine for that purpose.
Now tyrosine is one of the 20 amino acids that make up every protein in the human body (with the notable exception of collagen, which doesn’t contain tryptophan). But other than that, when I say every, I don’t mean that some proteins use 7 amino acids and some use 12, I mean that every single protein except collagen in the human body needs all 20 amino acids. You probably think of proteins in humans as something that builds muscle, but they do a heck of a lot more than that. Beyond creating the structures of our bodies, they create enzymes (like the enzymes you need to digest food), hormones, antibodies and other immune system cells. They also bind, transport and store molecules and pretty much do most of the work in cells. So basically, proteins are required for the structure, regulation and function of all of the body’s tissues and organs. So proteins are not just important, they’re fundamental to the functioning of a healthy body.
So when you’re under periods of acute stress, protein breakdown increases by as much as 20% and your body will start cannibalizing muscle tissue or the gut lining to get the nutrients it needs to make energy and proteins in your body. This can lead to intestinal hyperpermeability aka leaky gut, which can then manifest as food sensitivities, and if left long enough, autoimmune diseases.
You will also run through the B vitamins at a higher rate when under chronic or frequent acute stress because B vitamins are cofactors with enzymes, they’re used in the production of hormones and neurotransmitters and serve many other important protein-related roles in the body. Some examples are B6, which is required for the production of dopamine, serotonin and GABA, an important inhibitory neurotransmitter that can make you feel physically anxious when it’s in short supply; B12, which is used in the production of serotonin; and B5, which is used in making steroid hormones, like cortisol, which is also released by the body when we’re under stress.
Chronic stress also leads to decreased production of serotonin, which as I mentioned before, triggers peristalsis, or movement of food through the intestines. In fact, 95% of it is produced in your gut. So the lack of serotonin in the gut can lead to constipation, and also stagnation in the small intestine, which can lead to dysbiosis, candida or small intestine bacterial overgrowth, aka SIBO, leading to symptoms of bloating. Once microbes become overgrown, depending on which of them take over, you can end up with either constipation, soft stool or diarrhea downstream, or some combination of those.
What does stress do to your microbiome?
Another thing that happens during periods of chronic stress is decreased production of something called secretory IgA, or immunoglobulin A. Secretory IgA is a type of antibody, or immune system cell, that protects the mucus-lined surfaces of the body, including the intestines, and prevents pathogens from entering the circulatory system. Lowered levels of secretory IgA from stress can allow pathogens to attach to the gut lining, such as Helicobacter Pylori or H. Pylori, for example, and can lead to inflammation in the gut, ulcers and increased intestinal permeability. Then gut inflammation in turn can lead to dysbiosis and an overgrowth of opportunistic bacteria. In one of my clients I saw this exact pattern where a prolonged period of stress lead to what was probably a non-troublesome case of H. Pylori becoming a symptomatic case. Once we eliminated the H. Pylori and addressed some other aspects of her dysbiosis, her symptoms subsided.
Stress can also decrease the production of stomach acid, which is important for killing pathogens that come in with your food. One of the reasons for this is that B vitamins are necessary for the production of stomach acid, and as I mentioned, they become depleted during times of stress.
In addition, during periods of stress, some people turn to eating highly palatable, processed foods for comfort or convenience. These foods that are high in sugar and unhealthy fats have a major impact on which gut bacteria and fungi, like candida, grow and thrive. It turns out that the good microbes like healthy fiber from plants and the bad ones like sugar and white flour. In turn, these bacteria and yeast that are flourishing off of the highly processed foods and sugar are communicating with the brain by releasing neurotransmitters, metabolites and endotoxins (which are parts of the cell walls of gram negative bacteria) that can negatively impact your mood and your eating behaviors. Some of these gut microbes that grow can even encourage further dysregulated eating, which fuels the same cycle of stress and unhealthy eating, as well as a risk of depression and other mental health issues. Studies have found that individuals with depression tend to have less diversity in their gut microbiome, and have species of bacteria present that promote inflammation, which is why I’ve heard practitioners refer to depression as a disease of inflammation.
Studies have shown that gut dysbiosis is promoted by a high-stress lifestyle and a typical Western diet. One study done on university students showed that their balance of unhealthy gut bacteria increased as their stress increased over a period of time. This unhealthy balance can then deregulate the immune system, causing you to be sick more often, further increasing stress. Similarly, stress and depression can promote leaky gut, or intestinal permeability, which again promotes an inflammatory response. This again plays into the cycle of stress, inflammation, gut health problems and depression.
How can I protect my health while under stress?
So what are some ways to avoid playing into this vicious cycle of stress, a dysbiotic microbiome, and the negative health consequences? To start with, you could use a good probiotic during times of stress to increase your healthy gut bacteria and lower your risk of leaky gut and consequent inflammation. Some studies have implied that gut diversity can actually improve stress responses. One that studied Japanese medical students found that their sleep, stress, autonomic balance, bowel movements and cortisol levels all improved when they began to supplement their diets with probiotics.
A few probiotics for general gut health I’d recommend are Bifido Maximus*, a good, high-dose lacto-bifido probiotic; Proflora 4R (find in my Fullscript Dispensary), which is a spore-based probiotic that also has some gut soothing ingredients and Seed** (get 15% off with my affiliate code PARSONS15), which they refer to as a synbiotic as it also has prebiotic polyphenols in it.
And while probiotics are a great addition to any diet, of course the food you consume has an even larger impact on your gut microbiome. A typical Western/American diet that is high in added sugars, saturated fats and processed foods will lead to inflammation, dysbiosis and leaky gut. And let me just note that when I mention saturated fat, this is in the context of the Standard American Diet, not in the context of a ketogenic diet, which has benefits that are different because of the endogenous or internal production of butyrate, which feeds the gut colonocytes, or the cells lining your large intestine. A more traditional and gut-healthy diet is high in fiber from beans, legumes, whole grains, nuts, seeds, fruit and vegetables. It’s rich in polyphenols, which give plants their color, and unsaturated fats like olive oil, which also contains polyphenols, as well as Omega 3 fatty acids like you get from wild caught seafood and pastured-raised meats, dairy and eggs. This kind of diet promotes a much more diverse and healthier gut microbiome, which decreases inflammation and leaky gut and can promote mental health and lower stress. Studies in mice have even shown that inflammation in the colon significantly increases during periods of stress due to a change in the gut microbiomes of the mice.
Is stress related to IBS or IBD (Crohn’s and colitis)?
For people with existing gut conditions such as IBS, IBD or inflammatory bowel disease, that is, Crohn’s or colitis, the additional inflammation triggered by stress and the concurrent changes in the microbiome can be even more negatively impactful. In the case of IBS, not only does stress heighten the symptoms, it can even lead to the development of IBS in the first place. As I mentioned before, chronic stress can lead to dysbiosis, which is a major cause of IBS. Also in the case of IBS, around 40-60% of people also have a concurrent psychiatric diagnosis, such as anxiety or depression.
Similarly, for individuals with IBD, stress can also worsen their symptoms. Much like with IBS, many people who suffer from IBD also have a psychiatric diagnosis. Studies show that stress can cause flare-ups of IBD and can cause it to relapse. Interestingly, new research has shown that in two thirds of people who have both IBD and diagnosed anxiety, their anxiety began, on average, two years before their IBD. Also, people who had been diagnosed with anxiety or a mood disorder earlier in life were also diagnosed with IBD earlier than those who did not have anxiety or a mood disorder as a child.
Does stress cause ulcers?
Interestingly, a gut condition that many people believed for years to be caused by stress, stomach ulcers, is typically not. Stress can aggravate them, but typically it is not the root cause of this issue. Ulcers are usually caused by H. pylori and the overuse of anti-inflammatory pain medication, but as I mentioned, stress can give H. Pylori the opportunity to cause more trouble in the stomach and become symptomatic. And of all the things I work with clients around, H. Pylori is one of the worst in terms of symptoms of GERD, stomach pain, burping, bloating and insomnia, and when it’s gone, people feel incredible relief.
How can I reduce my stress and digest my food better?
So, if you have one of these conditions or undiagnosed gut issues and want to start addressing your gut health, it’s important to address the stress that caused or contributed to it in the first place.
First, use mealtime as a moment to enter into a parasympathetic, or “rest and digest” state. Turn off the TV, put away the smart phones; if it’s nice outside, sit outside and take at least 20 minutes to eat your food. Before eating, if you feel your body is tense, try a period of mindfulness where you take in input from all your senses before your meal, do some 5-5-7 breaths or a brief meditation. Try to chew your food 25 times before swallowing. If you have others around, make mealtime a time of pleasant conversation. We started some traditions like “Happy, Sad, Looking Forward To” when our kids were young. That’s when everyone says something they’re happy about, sad about and looking forward to. This helped create pleasant conversation and stopped some of the bickering between the kids at the table. Or we also did what we call “Family Rendition”, which was my younger son’s mispronunciation of “Family Tradition” which is where each person gets to choose one topic and they we all say one sentence about that topic.
Getting out in nature is also a great way to combat stress, so much so that some doctors are now literally taking out their prescription pads and writing a prescription for vitamin N. And studies show that the deeper you get into a natural area and away from civilization, the calmer your brain waves.
In terms of managing longer-term stressors, this can be more challenging. You can address the symptoms with practices like mindfulness, meditation, yoga or tai chi, and there are tons of good apps now to do that with. A couple of meditation apps that have been recommended to me are Calm and Ten Percent Happier.
Getting adequate sleep is also important for managing stress and incredibly important for detoxifying and rebuilding the body and brain. If you have trouble sleeping, practicing better sleep hygiene like putting away devices an hour before bed, stopping eating at least 2 hours before bed, making sure your room is completely dark with no blue lights, and sticking to a consistent sleep schedule, even on the weekends, are initial interventions. I also recommend to my clients who have issues with waking up worrying to set a time in their calendars each day to worry or list out all the things on their minds, so they won’t preoccupy them during the night. If you’re having trouble going to sleep, a couple good techniques are progressive tightening and releasing of your muscles up and down your body, or forcing yourself to keep your eyes open while repeating to yourself “Don’t close your eyes, don’t close your eyes”. It works brilliantly, trust me.
Other tips for managing stress include visualization, another aspect of mindfulness where you mentally place yourself in a positive, calm space. I like to take myself to North Litchfield Beach in South Carolina and the house we used to vacation at every summer. I then take in input from all my senses of what it feels like to be there.
Positive self-talk is also a key facet to managing stress and improving your self-image. Try and reflect on whether you would use the kind of language you say to yourself in your head or even out loud to another person. If you wouldn’t, work on being kinder to yourself and picturing and believing you’ll have a positive and healthy future.
It may help to keep a journal to note when you have stressful incidents and when they coincide with gut symptoms, so you can be more aware of the connection between the two. And if you’re struggling with stress from work, spend some time figuring out how to address it. That may mean being more firm in setting hours and sticking to them or talking to your supervisor about taking some work off your plate. This may mean having a conversation like: “I won’t be able to get to all these tasks this week, which ones are the highest priorities?” Or it may mean delegating some tasks or accepting something less than perfection on others. And it’s also important to take vacations, even if you can’t afford to go anywhere or are still in lockdown mode. Being a workaholic or working long hours is nothing to brag about if it’s hurting your health. Our brains badly need those weekend breaks, as well as longer week or two-week breaks periodically. Inevitably, my digestion drastically improves within 4 or 5 days of the start of a vacation so I have seen this play out in my life.
If you have IBS, IBD or other gut issues, joining a support group or a Facebook group to discuss your symptoms, ask questions and vent can be really helpful in not feeling so alone and can help alleviate some of the stress that come with these gut health issues. I have a Facebook group called Gut Healing where you’re welcome to come vent or ask questions.
And sometimes getting out from under chronic stress may mean taking courageous steps to make major life changes, like leaving a stressful job, taking a course on better managing your money or getting out of a toxic relationship. While I consider myself to be in a happy marriage now, there were times in my early marriage where the stress of the fighting with my husband was so bad, I remember sitting on the toilet and thinking – this is literally killing me; this is taking years off of my life. Fortunately, counseling, life changes, maturity, compromises, the passing of time and releasing of unrealistic and unfair expectations, as well as better self-control on both of our parts has helped us get to a much happier place.
And please don’t let fear or stigma stop you from seeking help from a licensed mental health professional. It’s done wonders for me in my life. And what’s nice is that now, unlike years ago, mental health treatment is covered by insurance in the U.S. like other regular medical care. You can even get couples therapy covered under insurance if it’s causing one of you mental health issues. So please, take that courageous step and find a therapist who fits well with you if you’re struggling with high stress.
Well I hope this has been helpful and will get you thinking more about stress and how it’s impacting your gut health and life in general. I have a practice I do every Friday morning, called super thinking. I go for a walk for 30-45 minutes or so without any distractions and I just think about my business and my life and problems I need to solve and come up with creative solutions for them. This is been really helpful in giving me the mental space to look at the big picture and think of bigger solutions for day to day stressors that aren’t going away.
If you’re looking to start solving your gut health problems and want to address the physical side of it as well as the mental, you’re welcome to set up a free, 30-minute breakthrough session with me. We’ll talk about what you’ve been going through and I’ll tell you about my gut health coaching 5-appointment program in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.
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**I am affiliate of Seed but do not receive a direct commission on their products.