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That sinking gut feeling

The effects of stress on the mind-gut connection and the promise of prebiotics


Ever experienced stress or nervousness and wound up in the bathroom shortly after? Or maybe you’ve gone through a stressful life change only to experience more chronic gastrointestinal (GI) distress. Or perhaps you’ve experienced a bout of GI distress and found that your depression and anxiety symptoms have worsened.

New research suggests that the connection between your head, nerves and gut may be stronger than anticipated.

Stress-related irritable bowel syndrome

It’s conservatively estimated that irritable bowel syndrome (IBS), a group of symptoms including abdominal pain or discomfort and changes in bowel movement patterns, affects 10-15 percent of U.S. adults. Most people with IBS also suffer from other GI conditions, such as reflux disease and dyspepsia, and non-GI-related conditions, including depression, anxiety, chronic fatigue syndrome, and more.

“In many cases where stress is the underlying factor, the GI tract is just an innocent bystander,” explained Dr. Jonathan Lamphier of Novant Health Gastroenterology Brunswick. “Patients may have abdominal pain, bloating, diarrhea, constipation, or some combination of those two. Some patients under stress will have those symptoms. Some will have tension headaches. Others will have back pain. Many of the functional GI problems we see are due to people leading stressful lives and not coping with stress in an optimal way.”

He gave a loose sketch of a typical patient who may show up in his office with stress-related GI symptoms. “It’s typically a young person, junior year of high school, now looking at going to college,” he said. “Junior year is more demanding. They’re feeling the pressure of becoming an adult and suddenly they have significant GI upset. This might be the type of individual who, when they were young, didn’t go to school on certain days because they had a stomachache or felt nauseated.”

Lamphier explained that the onset of IBS usually occurs in young adulthood and can persist intermittently throughout life. “For IBS to occur later in life without any prior symptoms is unusual,” he said. “In those cases we’d be more aggressive in ruling out organic disease.”

He added that age is usually a determining factor. “Younger adults who complain of abdominal symptoms that are vague, chronic and stable over time – 70 to 80 percent of those cases are functional problems related to stress. But they still have to be taken on a case-by-case basis to avoid missing the rare cases of colitis or other chronic GI conditions.”

Treatments and the promise of prebiotics and probiotics

Lamphier said such patients typically undergo a GI workup to ensure there is nothing wrong with the GI tract, but if there’s nothing functionally wrong they’ll be referred back to their primary care physician for a trial of antidepressants or a counseling referral.

“We can treat some of the symptoms, but we generally can’t make many long-lasting changes,” Lamphier said. “We can prescribe antispasmodics (to prevent colon spasms) and probiotics, but these generally work best in conjunction with treating the root cause of stress through psychological counseling and antidepressants or anti-anxiety medications, as needed.”

New research from neurobiologists at Oxford University suggests a strong connection between gut bacteria and mental health. The study found that prebiotic supplements, which are dietary fibers that boost healthy bacteria in the GI tract (different from probiotics which are actual strains of good bacteria), could have a positive impact on stress-related disorders, such as anxiety and depression.

The idea that the connection between the gut and the mind is a two-way street and that treating gut flora could positively impact anxiety and depression is an exciting one, Lamphier said.

“Every time I go to a GI conference I hear more and more about the microbiome,” he explained. “It’s fascinating and the true experts are the academic gastroenterologists and microbiologists who have the resources and dedicated time to research this further. But we’ve known for a long time that fiber is important for colon health.”

He added that probiotics have proven especially helpful in people with active IBS, especially ulcerative colitis and IBS that tends toward constipation.

When to seek help

Regardless of the suspected cause, Lamphier advised that anyone experiencing GI symptoms that interfere with daily living should consult his or her  doctor.

“Many times there are things we choose to live with that are sometimes minor, but sometimes they’re not,” he said. “Any time we alter our behavior because of our health, that’s something that should be evaluated.”





Published: 3/4/2015