Stress

Stress is an emotional or psychological state that is usually caused by environmental factors—a hectic, demanding, or chaotic lifestyle void of quiet and leisure may all lead to manifestations of stress. Those who suffer from stress may experience a feeling of pressure or tension building up within. Although stress is thought of as a psychological state, it causes physical, behavioral, and emotional symptoms, and can have incredible implications on the gastrointestinal tract, acting as a primary contributor to general digestive upset, as well as more serious digestive diseases and conditions. Researchers frequently refer to the “second brain” in the gut—the millions of nerve cells in the digestive tract that allow us to “feel” the inner world of our gut. This gut-brain interaction is essential for good digestive health and therefore, reducing stress is an important component in treating digestive diseases.

SYMPTOMS

If you think stress may be contributing to your GI symptoms but you’re not sure, here are some useful signs and symptoms to look for:

Physical Symptoms

Stiff or tense muscles, especially in the neck or shoulders
Headaches
Sleep problems
Shakiness or tremors
Recent loss of interest in sex
Weight gain or loss
Restlessness
Behavioral Symptoms
Procrastination
Grinding teeth
Difficulty completing work assignments
Changes in the amount of alcohol or food you consume

Emotional Symptoms

Crying
Overwhelming sense of tension or pressure
Trouble relaxing
Nervousness
Quick temper
Depression
Poor concentration
Trouble remembering things
Loss of sense of humor

Stress can contribute to and worsen nearly every digestive condition. Some of the most common digestive conditions that are strongly linked to stress include:

Constipation: Stress can disrupt the normal hormonal messages throughout the gut that are important for bowel regularity, as well as trigger the flight-or-flight response that diverts resources away from the digestive tract and suppresses the urge to evacuate stool. Being in unfamiliar surroundings or disrupting your normal routine with travel will often result in constipation due to a change in diet, anxiety over using unfamiliar bathroom facilities, jet lag, and dehydration.
Gut bacteria imbalance & infection: Stress can have a profound effect on gut bacteria. It is a major microbial disruptor and can act as a primary contributor to dysbiosis (bacterial imbalance in the gut). A study from Ohio State University showed that stress affects the amount of mucus production in the stomach, which changes the composition, diversity, and amount of gut bacteria growing in your gut. Not only is there less species variation with stress, but the numbers of potentially harmful bacteria rise, too, which increases your susceptibility to infection. It’s why when we’re run down, tired, and stressed, we’re more likely to get sick.
Irritable bowel syndrome (IBS): Stress is a common factor that contributes to IBS. There is a cohort of people whose IBS symptoms are entirely due to stress, but more commonly stress is an exacerbating factor, making symptoms worse. Like many people, you may have chronic stress in your life. You may also have been diagnosed with IBS. But could stress be causing your IBS? The answer is: we don’t know. Investigating your health history, symptoms, triggers, and lifestyle are important in uncovering the causes of your IBS and whether stress is contributing. If there is a question, seek out stress reducing techniques.
Leaky gut: If you have leaky gut, its original cause may have been excessive alcohol consumption, radiation treatment, chemotherapy, or the overgrowth of pathogenic bacteria, but chronic stress can lead to a weakened immune system, affecting your ability to fight off invading pathogens and worsening the symptoms of your leaky gut.
Digestive autoimmune diseases & food allergies: Stress also induces responses in the gut that can affect your immune system, including increased intestinal permeability associated with leaky gut, greater susceptibility to inflammation and infection, and alterations in the ratio of beneficial to harmful bacteria (stress suppresses what essential gut flora we do have). Along with alcohol and a high-fat/high-sugar Western diet, these stress-related gut responses lead to a hyper-reactive immune system primed for autoimmune disease and allergies.
Hormone imbalances: Stress is an exacerbating factor for thyroid disease and is a risk factor for immune mediated forms of thyroid disease. Stress depletes progesterone levels and worsens estrogen dominance. Although stress is sometimes thought to be the primary cause in some digestive diseases and conditions, most often it is one cause, among others, that contributes to and ultimately triggers the manifestation of disease. The serious effects stress can have on the digestive system should not be ignored; stress (along with other factors such as poor nutrition) can unmask the effects of a damaged microbiome and can lead to a multitude of symptoms and a decline in overall well-being.

CAUSES

You may wonder how an emotional or mental state such as stress can cause physical symptoms that potentially lead to disease. There is a very clear physiological explanation linking stress (a psychological condition) to physical manifestations. When presented with a stressful event (for instance, let’s say you stumble upon a large black bear in the woods), the body responds in very physical ways; the adrenal glands send hormones coursing through the body, including adrenaline and cortisol, mediators of the “fight or flight” response that provide us with quick bursts of energy. As a result, your heart rate increases, you start to breathe fast, you get sweaty, the hair on your body stands on end, your blood pressure goes up, and your pupils dilate. This adrenal response strongly affects the digestive system as well: it increases stomach acid production, causing heartburn and nausea; shunts blood away from the intestines, interfering with digestion and absorption of nutrients; decreases enzyme secretion; slows down stomach emptying; and speeds up colonic contractions. In times of stress or threat, the adrenal system diverts resources from the digestive tract, so that all energy and attention can be focused on the stressor at hand, protecting our survival. Once the danger passes, the relaxation response kicks in, allowing everything to get back to a normal, mellow state. But modern life tends to keep many of us constantly revved up. Our body experiences this as an onslaught of one stressor after another. This chronic fight-or-flight, stressed-out state can have the following devastating effects on the body:

It impairs our ability to think clearly,
Decreases thyroid function, immunity, and bone density,
Increases blood pressure, blood sugar, and inflammation,
Accelerates the aging process so we don’t just feel stressed out, we look it, too,
Affects weight distribution, increasing deposition of belly fat that’s associated with metabolic syndrome and a higher chance of dying.

These physical manifestations of chronic stress lead to chronic digestive upset and gut bacterial shifts that can result in serious disease.

DIAGNOSIS

Diagnosing Stress

Stress is typically a clinical diagnosis based on how a person feels. Assessing one’s lifestyle, environment, and daily demands and schedule, as well as personal, medical, and emotional history, can help in diagnosing stress. Being familiar with the physical, emotional, and behavioral manifestations of stress is also a helpful tool in diagnosing or self-diagnosing stress.

Diagnosing Stress as a Cause of Your Digestive Problems

When diagnosing the cause of your digestive problems, stress is an important factor to consider, as stress is often a major contributor to digestive upset, and stress reduction proves an incredibly effective treatment for many digestive disorders. Although stress can be an incredible contributor to your digestive distress, keep in mind that it may not be the whole story. Most digestive disorders have more than one cause and often, stress is a contributing factor, and not the main cause. Be wary of conditions like bacterial overgrowth, leaky gut, and irritable bowel syndrome –all conditions that a decade ago we thought were “all in people’s heads” but we now know they are caused by very real gastrointestinal disturbances. Thinking outside the box and realizing that stress may not be the only cause can help you find both the source behind and the remedy for your digestive distress. This means taking an honest and well-informed look at your diet, the medications you are taking, your health history and symptoms, your exercise routine, as well as your stress levels.

The Role of Stress in the Diagnosis Process

Stress can also influence how you are diagnosed and treated. When people appear anxious and stressed during medical appointments, it can be distracting for the physician, who may then surmise, incorrectly, that stress and anxiety are the only problems at hand. This error happens far more frequently with female patients. Women suffer needlessly and doubt their own intuition about their bodies when their complaints are attributed purely to stress. In these cases, a more thoughtful and comprehensive diagnosis and treatment plan is usually needed—which of course, might include stress reduction. If you are told that stress is what’s causing your digestive distress and you are unsatisfied with the diagnosis or are convinced there is more to the story, be persistent. Our body has its own innate sense of when something is wrong, and it usually encourages us to seek answers and solutions even when mainstream medicine is telling us we’re fine or failing us in other ways. Ultimately, our bodies have a wisdom that should not be ignored.

TREATMENT

If you think stress may be to blame for some of your digestive problems, seeking out methods to reduce your stress is important and may even save your life. Recommended integrative treatment methods for reducing stress include:

A Mental Health Assessment & Talk Therapy

If you think you may be depressed, anxious, or overly stressed, it may be important to have your mental health assessed by a professional, especially if you’ve been diagnosed with a digestive condition (like IBS) and told that stress is partly to blame. Seeing a therapist and undergoing talk therapy may be helpful in reducing your stress and treating your digestive symptoms.

Gut-directed hypnotherapy (GHT)

Gut-directed hypnotherapy (GHT), hypnosis focusing on gut-related issues, to relieve stress has been found to be an effective therapy for IBS in several studies, and superior to medical treatment alone. Quality of life outcomes are improved, and it has a long-term positive effect, even in difficult to treat cases of IBS.

Exercise

Exercise, or simply moving your body, is a longtime solution for stress, as it increases endorphins and promotes better sleep, both mechanisms that can drastically reduce stress.

Yoga

By relaxing the mind and moving the body, yoga proves effective in managing stress. Studies show that yoga can raise levels of the feel-good hormone serotonin as well as endorphins, and decrease stress-related hormones like cortisol, improving mood and reducing stress.

Meditation & Breath

Breathing is a type of meditative practice that can relieve stress and anxiety and may help in treating your digestive distress. Follow this breathing model to help manage your stress:

Place one hand on your chest and the other on your abdomen.
As you inhale slowly, your bottom hand should move up and out and your top hand and your shoulders should remain relatively quiet.
As you exhale, your bottom hand should move back in. (If you’re having trouble with this, place a 5-pound bag of rice on your abdomen so that you have a physical sensation of where to place the breath.)
Now take a slow breath in your chest and notice how it produces tension in your neck, shoulders, stomach, and back.
Now exhale, allowing all the tension to leave your body. Notice how tension is associated with “chest” breathing and the relaxed feeling you have when you breathe diaphragmatically; that is, when the abdomen moves in and out and the upper body stays quiet.
Inhale to a slow count of 4 (inflate the abdomen)
Exhale to a slow count of 6 (deflate the abdomen)
Modify to a count of 3 for inhalation and 5 for exhalation if necessary for comfort
Regardless of the count, your focus should be on exhalation, which should be longer than inhalation.
If at all possible, practice for 20 to 30 minutes twice a day to truly realize a change in how your body reacts to stress.

(Courtesy of Emily Perlman, MS, BCB. Adapted from Richard Gevirtz and Paul Lehrer.)

Other types of meditation have proven effective in relieving stress, including Transcendental Meditation (TM). TM alone leads to startling changes in heart rate, metabolic rate, and breathing rate and studies show that people who practiced TM have much lower blood pressure.

Massage

Studies have found massage beneficial for stress relief, anxiety, depression, boosting immunity, treating pain, improving stiffness, and even cancer therapy. Massage also has a hugely beneficial effect on the GI tract, particularly in people with IBS and chronic abdominal pain.

Promoting a Healthy Microbiome

Recent studies show that gut bacteria may be associated with stress, anxiety, and depression. Therefore, promoting a healthy microbiome is important in reducing and managing stress, as well as in practicing resilience in stressful situations.