when stress & anxiety (not food) cause digestive problems.

Happy second day of the week, friends!  I first want to say a warm & fuzzy thank you to all who expressed support for the health at every size and intuitive eating things that will become a bigger part of the scene here on TMT. Many hugs to you :).

In other news, I also ate some yum pancakes this past weekend. I haven't made pancakes in like 6 months and it was lovely.  

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Also in other news, TMT activity has been lacking. I have been having photo issues (because I understand nothing about web formatting), so right after my big "Yay for the new year!" post, not much, friends. Not much. However, I have been thinking moreso than doing in general, because I find January a contemplative time. I'm an over-thinker and detail-oriented kiddo to begin with, so the freshness of January always brings SO MUCH to think about, you know?

Because the internet during January is obviously drenched in "fix your diet/body/exercise/etc and it will fix you" stuff, and because I work in health care so healthism is freaking EVERYWHERE, a good bit of this thinking-time has been related to characterizing, defining, and conceptualizing *health* outside of these things. This has resulted in 1) me trying to floss, and 2) looking at all of the thought-energy I spend related to stress and/or anxiety. With this post, for example, stress/anxiety pops up in the form of thoughts. Like deciding whether or not to publish this for fear of comparison. Or that it is irrelevant. Or that no one will read it. Or that it won't have helped anyone. But all of that leads to anxiousness, and nothing else. UGH. Sometimes our minds are not our friends. BUT I'm working on it, so here we are :)

Speaking honestly, much of this past year was characterized by periods of stress and anxiety (welcome to adulthood, Alyssa), and it really affected me physically. I am one of those kids who literally feels stress when it comes to digestion (what up, IBS), so moving towards acknowledging the stress and anxiety that I hold onto, and working towards *better* ways to handle them, has indeed led to positive shifts in my physical being. It is also still a huge work in progress, reader friends. 

Not for lack of there already being some really wonderful posts on the internet sphere about stress and anxiety, but because I have been experiencing this personally (and can relate :D), I thought it would be super fun to ramble a bit on how stress and anxiety can affect digestive health at a high level. I am not saying that food plays zero role in digestives issues (obviously a very wide spectrum there), but I am saying that stress and anxiety can have a noted impact on the digestion situation in the context of functional gut disorders (in my case, IBS). Because I am a researcher (yay RDs in research!) I've included a few citations, because I am not just pulling this stuff out of my own experience. Also a disclaimer: this is general info, and if you have specific concerns, PLEASE seek care from your provider. 

Here we go!

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The bigger picture. 

Stress and anxiety can potentially affect anyone's digestion. Because if you are human, you have some stress, and likely some anxiety at times. If you are a sensitive human (MEEEEEEE), perhaps your GI system knows it, too. It bothers the crap out of me that a lot of New Years diet resolutions are all about cutting things out, with the promise that it will improve digestion, bloating, diarrhea, constipation, abdominal pain, etc. As I have my own diagnosis and have treated people with gut disorders/diseases/allergies, it is highly upsetting to see people's vulnerability exploited. When dealing with terrible, awful digestive symptoms, it becomes very attractive to adopt an elimination diet or lifestyle (e.g., no dairy, gluten, sugar, soy, grains, etc) with the hope that it will ease these very real, very nasty digestive issues. Again, there is a lot of stuff, often that is highly individualized, that goes into digestion. BUT sometimes the issues don't have anything to do with food. We're just told that it does. 

I have totally been there. It isn't much of a jump to notice the relationship between miraculous promises of improved digestive health and increasingly drastic elimination diets, and OF COURSE people who struggle with digestion will be all over it. Who doesn't want to feel better? But looking at the bigger picture, and paying attention to stress and anxiety, may actually help us get closer to the root of digestive symptoms.

 

Stress & Anxiety.  

Simply put, stress comes in many, many, MANY forms. Home life, work life, poor sleep, too much or too little exercise, poor self-image, internalized stigma, any disorders/conditions/diseases, and relationships all contribute to stress (1,2). Anxiety is a reaction to stress, and they fuel each other in a sort of feedback loop. People who struggle with anxiety have a higher perceived level of stress, or may struggle with anxiety because they have high-stress lives. We live in an increasingly socially anxious society (according to the people who study this stuff), and our cultural norms (like long workdays, social media usage, irregular sleep) appear to contribute to higher levels of stress in general (1-3). 

We could tease it out further, but to keep it high level, everyone has a threshold. There is a level of stress that is healthy, but that is far more the anomaly than the norm, and is highly subjective (1). When looking at your lifestyle, maybe it doesn't seem as full as someone else who appears less stressed than you. But for you and your body (and digestion), maybe everything, collectively, is too much.  

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Why they matter. 

When having digestive symptoms, to only look at food is to make the assumption that the symptoms are 100% coming from the food. But this is ignoring that our digestive system is affected by lots of things in our body besides food. It is where most of our immune system is (>70%), houses a microbiome (that honestly we don't know too much about), and is in constant communication with the brain (hello, vagus nerve!), just to name some major ones. This complexity is why the GI system is so wonderfully (and infuriatingly) difficult to study. 

The point is that stress can absolutely affect your digestion. Because your gut and brain talk to each other constantly, when your brain is like, "AH! STRESS!", your gut might feel it too. In some people, this link appears to be more sensitive (it's called visceral hypersensitivity), and they are more likely to have stress and anxiety physically manifest itself in digestive issues. This is the case in people with IBS (1,3,4). 

But there are plenty of totally normal things, too, that can cause weird or altered digestion, simply because your brain and gut are always communicating. Super common sources of stress are:

Everyday stress.

If your sympathetic nervous system (the fight or flight response) is ON, it makes digestion harder (1,3-5). This is because it opposes your vagus nerve, which operates in the parasympathetic nervous system (your relaxation response) and promotes digestion. If you had an incredibly stressful day (daily commute, anyone?), you may have noticed that your stomach was acting all sorts of weird, like a wonky appetite, achiness, or bloating -- your GI system quite literally had less messages from your brain for digestive functions, making it less able to do its job. 

Additional stressors, like exercise. 

Exercise is interesting, and can acutely or chronically influence digestion. During intense exercise, all of the blood that your digestion requires is being shunted away from your digestive system and instead being delivered to your muscles for oxygen. This is because our muscles require oxygen during exercise, and because you only have so much blood, your muscles get first priority when exercising. Of course exercise has many physical benefits, but this sharing of oxygen is why some people might not want to eat something that takes awhile to digest right before exercising (hello, angry bowels). But chronic over-exercising can lead to an ever-present source of stress, putting you in fight-or-flight mode more often than may be beneficial (1,5).  

Sleep. 

If your sleep is terrible, your body wakes up with elevated stress hormones, which in turn can put you in sympathetic nervous system mode (1,3,5). Throwing a bunch of caffeine (ahem, a stimulant) on it in the form of delicious coffee to help you conquer the day (again, anyone else?) can actually cause some abdominal pain, no matter what you eat for breakfast. 

 

In sum: your gut isn't broken if you sometimes have digestive discomfort. It is simply a product of life, because life isn't stress-free. 

 

Given that there are many possible sources of stress and anxiety in modern life, it actually makes good sense that from time to time people experience digestive yuckiness. And we didn't even talk about different foods. Crazy, yes?

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You (& me). 

The funny thing is, if you have something like IBS, you are likely over-stressed and may deal with anxiety (3,4). This can turn into a vicious cycle, because it can create a stressful, anxious experience and association with eating that, in turn, worsens digestion. As in the more you stress about food, the worse the symptoms could be, because stress is what is causing the symptoms in the first place.

When rooting out the causes of my own digestive stuff, I overall did receive great care. What wasn't addressed, however, was how I dealt with stress (it freaks me out) and I continued to struggle with IBS symptoms for quite some time. I won't say that I never have IBS symptoms, because I do (no one has a stress-free life, yes?). But I now recognize that they correlate quite strongly with my emotional state and how I perceive stress, rather than what I ate at my last meal. It has taken time, but it has removed a TON of mealtime anxiety. I eat all sorts of foods that I was previously terrified of, because they were "going" to give me digestive issues. I am not trying to be too anecdotal, because I want to be evidence-based in what I share. But, as stated above, it is well-supported that stress and anxiety directly affect our digestion (1,3,4). 

I'm intentionally leaving food out of this conversation, because I want to show that we can take back some power by recognizing that food is not the end-all be-all to our digestive health. The digestive symptoms may not be the issue; it may actually be your body showing you that you are chronically dealing with unhealthy levels of stress and anxiety for you, and that is what needs your attention. 

Of course, I am not saying that all digestive problems will be magically solved with a better self-care regimen or don't require investigation. I am saying that jumping headfirst into a restrictive diet (lifestyle?) is actually more often creating stress and anxiety around food. This is the exact opposite of what we want to do for our bodies, no matter what the root cause of the symptoms. All I hope to communicate is that life is hard, and sometimes our bodies acknowledge it before we do. And you absolutely don't need someone telling you to add another source of stress to your life in the form of a rigid diet. Yuck. 

If nothing else (and assuming you're still with me), stress and anxiety absolutely need to be part of the discussion when dealing with digestive symptoms. Especially as you try and navigate why one day your stomach is fine and the next day you're doubled over in pain, it can be really hard to be accepting and compassionate towards yourself. Of course I'm not saying to self-diagnose; rather, I'm saying don't let someone trying to sell you a diet/lifestyle/whatever diagnose you, either. Sometimes, digestive symptoms need to be addressed and treated. But sometimes, they're just part of life. 

I'm grateful I'm a dietitian, because it has opened me up to the extremely fascinating and complex GI system. I'm also grateful because it has helped me explore how to approach these issues, both personally and professionally. I'm learning with you, friends :) 

 

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PS: the hodge-podge of photos (whose quality is STRESSING me out, lol) shared in this post all included foods/ingredients that were previously "off limits," because I thought that it would inevitably lead to digestive problems. I ate all of these things this past week :).  

PSS: once I acquire the skills to fix my photo problems, some seriously LOVELY cranberry almond oatmeal cookies (aka the gem pictured above) will be coming to TMT. 

PSSS: if you would be so kind, dear reader, please drop a comment on whether or not you would enjoy more posts of this nature. Or if you want me to shush and produce more baked goods. 

xox

Alyssa

 

 

references:

1) National Institue of Mental Health. https://www.nimh.nih.gov/health/publications/stress/index.shtml

2) Twenge, J. M., Gentile, B., DeWall, C. N., Ma, D., Lacefield, K., & Schurtz, D. R. (2010). Birth cohort increases in psychopathology among young Americans, 1938–2007: A cross-temporal meta-analysis of the MMPI. Clinical psychology review30(2), 145-154.

3) Pellissier, S., & Bonaz, B. (2017). Chapter Eleven-The Place of Stress and Emotions in the Irritable Bowel Syndrome. Vitamins and hormones103, 327-354.

4) Coss-Adame, E., & Rao, S. S. (2014). Brain and Gut Interactions in Irritable Bowel Syndrome: New Paradigms and New Understandings. Current Gastroenterology Reports16(4), 379. http://doi.org/10.1007/s11894-014-0379-z

5) Stakenborg, N., Di Giovangiulio, M., Boeckxstaens, G. E., & Matteoli, G. (2013). The versatile role of the vagus nerve in the gastrointestinal tract. EMJ Gastroenterol1, 106-114.