A gastroenterologist explains how stress, lifestyle changes and COVID-19 could be giving you a bad "gut feeling."
Have you ever had a gut feeling about something? That feeling comes from your second brain: the gastrointestinal (GI) system. The GI tract has its own internal nervous system lining that relies on thousands of neurotransmitters (the same ones in our brain and spinal cord) to function appropriately. Much like our central nervous system, this too can be affected by psychological, social and emotional stress.
In the era of COVID-19, stress and lifestyle changes have not only impacted our daily life, but also our eating habits. To learn more about the impact of COVID-19 stress on gut-related issues, we spoke with Dr. Christopher Henry, a gastroenterologist and hepatologist at Thomas Jefferson University Hospital.
Why does stress affect the stomach?
The GI tract is a vital and complex system. Stress and our gut live on a two-way street: Stress can cause a variety of symptoms, but having symptoms, such as pain or nausea, can also be stressful. This back and forth response can lead to a vicious cycle that amplifies both stress and symptoms. It can often be difficult to determine which came first.
Since many of us are now sitting at home and less active, a change in our usual diet and activity could lead to changes in our digestion. While at home, we also have more time to focus on symptoms we may previously have been unaware of or even ignored. On the other hand, being at home has caused new personal, professional or emotional stressors. Maybe a change in diet has increased the frequency of reflux, but this reflux is creating stress because it’s unclear why it’s getting worse. Now, stress and discomfort are worsening simultaneously. How can we tell which is which?
What are some of the challenges in identifying digestive issues?
Digestive issues range from infections to inflammatory disorders, like ulcerative colitis or Crohn’s disease, to functional disorders like irritable bowel syndrome. Despite being distinct diagnoses, the symptoms can often overlap with pain or a change in bowel habits. What makes this field so interesting and unique is that it’s a symptom-based field. While you see a cardiologist to treat heart disease or an oncologist to treat cancer, you typically see a gastroenterologist because you have nausea or bloating—you come in with a symptom rather than a diagnosis. So really, we have to start off like detectives. We collect information about symptoms and suggest testing in order to arrive at the right diagnosis so that we can ultimately personalize treatment.
When you first identify a new symptom or digestive issue, you can start the detective work at home. Rather than just assuming it’s from stress, start by paying attention to other changes or triggers. Some hallmark signs to notice include changes in bowel movements, what makes it feel better, what makes it feel worse or if there’s an association in symptoms with certain foods. These details will help guide providers to evaluate stressors and identify underlying causes.
Has there been an uptick in gut-related issues since the onset of the pandemic?
Since March, we have certainly seen an increase in gut-related symptoms. While increased stress during a global pandemic certainly seems like a plausible cause, understanding why these symptoms occur is less clear and very interesting. From a simple standpoint, people are eating differently and are less active because of quarantine, which can lead to more symptoms associated with a sedentary lifestyle. On the other hand, those who are not at home are wearing masks, which also changes how often or when it is safe for them to eat or even hydrate. To be clear, I think people should be wearing masks, but this “new norm” has changed our routines and the trickle-down effect may be in the gut. Now, layer in the possibility that increased stress and anxiety increases awareness and possibly the severity of these symptoms.
What myths exist about stress-related gut issues?
The biggest misconception is that gut issues are all in your head. The symptoms are real and the stress is real. Another misconception is that the only treatment is to avoid stress. That recommendation is not only stressful in and of itself, but it’s also not feasible. We are currently living in a stressful time, and often live and work in stressful environments. Sometimes stress cannot be avoided. But, there are options. The symptoms you experience are real and, with the right team, you can begin to explore the gut-brain link and how to come up with a plan that works for your triggers and your lifestyle.
Are there treatment options available for digestive issues?
There are many treatments available that can be personalized and target the gut-brain connection. For example, in the treatment of irritable bowel syndrome, options include medications, dietary changes, natural supplements or stress reduction techniques, like therapy. Sometimes, psychological intervention like Cognitive Behavioral Therapy (CBT) helps patients proactively change their counterproductive behavior and improve their mental health—which pays dividends down the line. Regardless, the goal of treatment is to repair the communication between your gut and your brain.
In general, what should patients know about digestive disorders and issues?
There is never a wrong time to reach out. It is always appropriate to call your primary care provider or GI doctor about new or worsening symptoms. Never ignore “red flags” like unintentional weight loss, bleeding, persistent change in bowel habits or worsening pain.