A gastroenterologist breaks down mind-gut dialogue, the potential impacts of prolonged stress and trauma, and what you can do about them.
The reason you feel “butterflies” when you’re nervous – or your stomach gets upset before a big presentation – is the same reason the body can develop stress ulcers and other frustrating, chronic gastrointestinal issues. The gut is in constant communication with the mind.
During the pandemic, widespread spikes in anxiety have played a role in gastrointestinal diagnoses, says gastroenterologist Cuckoo Choudhary, MD. Many people, particularly women, internalize stress, which can manifest physically, explains Dr. Choudhary. Studies have shown a significant increase in patients seeking healthcare for GI symptoms from before the pandemic to now.
But even before the pandemic, stress has always been linked to common GI concerns, such as irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD), in part due to the mind-gut connection (or the gut-brain axis).
How do the mind and gut communicate?
Multiple physiological processes are behind why stress can cause acute symptoms (like butterflies) or chronic symptoms (like recurrent or worsening episodes of diarrhea or indigestion), says Dr. Choudhary. They include:
- Gut neurons – The gastrointestinal tract contains more than 500 million neurons, which are an integral part of the nervous system, connected to the brain. A key component of the Central Nervous System, the Vagus nerve, regulates internal organ function and connects the gut and the brain. Signals are continuously sent in both directions.
- Neurotransmitters – Serotonin, dopamine, and GABA – all commonly referred to as feel-good hormones, known for reducing depression and anxiety – aren’t only produced in the brain. They’re produced in the gut as well, within healthy gut microbes (or micro bacteria). This is the same gut bacteria that comes into account when talking about probiotic consumption for gut health.
The Enteric Nervous System (ENS), embedded within the GI tract, is sometimes perceived as the “brain of the gut,” continues Dr. Choudhary. The ENS regulates movement of the GI tract, blood flow, hormone production, and more. A growing area of research, some studies have pointed toward the ENS being highly intertwined with our stress response and overall mental health.
How it turns into an endless cycle
The mind-gut connection is a two-way street, says Dr. Choudhary, which unfortunately means that poor health of one can hinder the other repeatedly.
“Mental illness, like anxiety and depression, can lessen the production of neurotransmitters in both the brain and gut. As the mind suffers, the gut mirrors it. Unfortunately, we see some patients become even more stressed over their GI symptoms getting worse. Thus, again, potentially exacerbating everything.”
Are stress ulcers real?
Yes. Stress ulcers are superficial erosions that form on the surface of the upper GI tract. They can result from prolonged anxiety, but more often after intense, sudden periods of stress, such as the shock of a traumatic injury of loss of a loved one, explained Dr. Choudhary. Use of NSAIDs, such as aspirin and ibuprofen, can worsen ulcers and postpone their healing.
“Symptoms of stress ulcers will commonly overlap or worsen from other GI complications, such as GERD,” adds Dr. Choudhary. “Stress reduction plays a huge role, but it’s not as easy as flipping a switch. Ulcers don’t develop overnight, so they won’t heal overnight.”
Protein pump inhibitors, or PPIs, such as omeprazole, pantoprazole, and sucralfate may be prescribed to help regulate stomach acid and prevent further damage.
How do you determine what symptoms stem from?
With GI health, there’s usually not one clear-cut answer as to why it’s acting up, says Dr. Choudhary. “It’s always necessary to consider how stress might be impacting it. Of course, we also want to ensure we don’t miss any other physiological concerns, like an infection – such as COVID-19 – intolerance, or a motility issue. You have to look at the whole picture.”
If test results come back normal, with symptoms not subsiding, it’s an indicator that mental health is at play, continues Dr. Choudhary.
What you can do
If you experience any symptoms – such as a change in bowel habits, bloating and excess gas, cramping, acid reflux, or nausea – that persist or worsen, talk to your doctor. Some symptoms, such as blood in the stool and unexplained weight loss, can point to something more severe and should be addressed as soon as possible.
If you’ve already been evaluated, and your tests are normal, that’s good news; but you still have to figure out how to manage and reduce symptoms, says Dr. Choudhary. It’s recommended to combine treatment with lifestyle changes. Stress-reduction techniques; professional psychiatric help; and a diet full of probiotics, fiber, and vitamins to fuel healthy gut bacteria can all be incredibly helpful. Talk to your doctor about what changes are right for you.