IBS and anxiety can negatively impact some of the most meaningful and connecting moments in life. It can turn a casual get-together or date sour. People who experience IBS can constantly worry about having another attack. Agoraphobia is common too – the fear of leaving home. It’s understandable why people who experience IBS issues experience heightened anxiety around everyday situations.
People with IBS can sometimes feel powerless, like the best they can do is avoid food triggers.
Yet one of the main causes of the inflammation of the gut is your brain.
We’re going to look at the link between anxiety and the gut so you can understand your body better. You’ll learn how anxiety impacts your gut and how to listen to your gut’s activity as a signal. My hope is that by learning to pay attention to yourself in a new way, you’ll be able to not only avoid difficult IBS symptoms, but to learn how to soothe anxiety and feel more like yourself.
The gut is connected to the brain? How? Why??
First of all, all parts of the body have a bi-directional connection with the brain. In fact, the purpose of the brain is to receive input from the entire body, make sense of it contextually, then relay a response that changes the body. The reason the gut-brain connection often needs special explanation is because it’s hard for us to think of the gut as a part of the body that would need connection with the brain. Isn’t the purpose of the gut kind of passive? Don’t we just digest food there? Why would it need to be connected with the brain?
There are 2 reasons worth exploring.
First, what we eat tells us a lot about our environment.
When we’re full, for example, it’s a signal that our bodies are safe, we have what we need. When we’re hungry, that’s contextual information too. We can extend this to how our bodies feel when we eat certain foods. All of this is good information that should impact our intuition about our environment, something the brain is always trying to grasp.
But there’s a second reason for the connection as well:
The gut needs context to do its job well.
Imagine, for example, you have a 16oz steak you’re trying to digest (something that requires significant blood flow and energy), and suddenly you need to run from a threat. If the gut didn’t know there was a threat, it would continue to try to digest the steak and you would be unable to run. But since your brain is connected to your gut, your gut receives a signal to stop digesting (and in some cases to vomit or defecate) so you could use that blood and energy for your heart, lungs, and muscles. In contrast, when you feel safe, you’re surrounded by loved ones, and you eat a satiating meal, your brain tells your gut it’s time to dig in.
In this way your mental state – ideally a result of your intuition of your current environment – impacts the permeability, blood flow, gut microbiome composition, and digestive enzyme composition… and vice versa.
There are 2 main pathways by which your brain and gut interact: a hormonal pathway and a neural pathway. Both pathways are bi-directional, meaning that the activity of the gut impacts your brain, and also that the activity of the brain impacts the gut.
The cortisol pathway: stoking the fire
The hypothalamus-pituitary-adrenal axis (HPA axis) is the hormonal highway between your brain and your gut. The hypothalamus’ job is to keep your body in homeostasis – to keep things in rhythm. When you wake up in the morning, like clockwork your hypothalamus signals to your pituitary to produce adrenaline to get your body moving. Your adrenal glands in turn release cortisol. Your gut has cortisol receptors that signal to the gut that it’s time to move around. This signal changes the composition of your gut biome, your gut biome’s permeability, and blood flow.
Cortisol, over time, creates a leaky gut that is vulnerable to IBS episodes.
The vagal pathway: dousing the fire
Your body also needs a way to soothe itself and return to normal. This is the job of your vagus nerve, which signals for your body to slow back down. If cortisol is like gasoline on the fire, then your vagus nerve is like cooling water that helps the gut return to normal. The vagus nerve is part of your parasympathetic nervous system, which is the way your body returns to safety and calm.
The vagus nerve runs down past your heart, lungs, and gut. When you see something sweet or comforting, you might feel an opening sensation in your chest and put a hand over your heart. You might take a deep breath and say “awww”. This wonderful sensation is your vagus nerve signaling for your heart, lungs, and gut to open up and slow down.
When your gut receives the vagus nerve signal, lots of things change. The vagus nerve signal:
- Starts an anti-inflammatory process in your gut
- Slows the cortisol signal
- Enforces a stronger gut barrier (decreases gut permeability)
The vagus nerve signal builds a strong gut environment that protects you from IBS episodes.
What an IBS episode looks like inside: Anxiety as a firestorm
When your body is in extreme and prolonged states of stress, high cortisol levels keep the gut in an inflamed state, leading to chronic changes in the gut microbiome and difficulty processing food. This puts the gut – and brain – in a fragile position, or a high “allostatic load”: the cumulative burden of multiple stressors. In this fragile state, any additional stressor can set off a spiral much like a spark will ignite a dry pile of hay.
An additional stressor could be anything: an inflammatory food, or a psychological or environmental stressor, or a combination of all three. While the trigger may be like a spark that starts the fire, the real issue is not the spark itself. The real issue is the spiral – the firestorm – left unmitigated.
When your body gets anxious, it usually has methods to calm back down.
We call this self-regulation. It’s like a fire hose that stops the emotional mind from getting overwhelmed. We might think of a person who is able to take a deep breath when they feel stressed, or to reassure themselves of a positive outcome when they are auditioning. This calming ability happens in our frontal lobes. The orbital frontal cortex and our anterior cingulate helps us soothe ourselves by bringing to mind soothing experiences from our past. We quite literally pull into mind a comforting memory, perhaps a parent rubbing our backs when we’re scared. For someone with a panic disorder or IBS, this frontal lobe circuitry isn’t strong enough to combat the flames of anxiety.
Thus, in an IBS episode, anxiety creates inflammation in the gut either directly or via the HPA axis. In turn, the gut sends a stress signal back to the brain that there’s a problem. If not soothed, this signal triggers the HPA axis, and we release more cortisol into the gut. The changes in our levels of cortisol change our brains as well. When in a panicked state, our frontal lobes shut down in order to get to immediate safety. When this happens, our ability to soothe ourselves is inaccessible. It’s as if the raging fire destroys the few available fire hoses.
When our level of stress passes a certain point, we are unable to stop the spiral: the fire will simply exhaust itself. For those who experience IBS, this is a familiar emotional place: the depressing surrender to an uncontrollable experience.
So what can you do? How to stop the firestrom of anxiety and heal IBS
It’s common for people with IBS to simply avoid triggers. This often means making a list of foods that trigger an attack and avoiding the list as much as possible. Yet, if we think about IBS as a complex neurological pattern that doesn’t simply originate in the gut, but in the relationship between the brain and the gut, then we can start to think about healing in a different way.
1. Create a calmer baseline
Part of the reason certain foods are triggering is the fragility of your gut – the baseline level of functioning that exists. Earlier we referred to this as the “dry bed of hay” that is ready for a match to send it up in flames. What would it mean to have less fragile intestine? Part of what creates fragility in the gut is chronic stressors, or high allostatic load. Elevated cortisol changes our entire physiology. In a real way, anxiety is not simply a “feeling” that impacts IBS – it’s a bodily state.
As such, our blood flow, immune response, inflammation of gut lining, and even our gut microbiome change dramatically when cortisol is present. When our bodies are in chronic stress, our gut cannot heal. The gut stays in this permeable, inflamed, stressed state. Healing our gut doesn’t simply mean avoiding triggers, it means increasing the times when we are completely relaxed and safe. The “safe feeling” we get when we sit down to talk with a trusted friend, when we meditate or pray, or when we receive a long hug, is an indication of our physiology returning to a soothing baseline. That state is what your gut needs to reduce baseline inflammation and restore your microbiome.
2. Grow your Self-Awareness
While some triggers may be food-related, other triggers may be contextual. When looking back at recent attacks, we can wonder about larger contexts that might have created a higher cortisol response. It’s highly possible that attacks are due as much to your emotional state as the foods you eat.
If you are unaware of the cause of your anxiety, you are also unable to self-soothe. To use our fire analogy, a lack of self-awareness is akin to having a fire department that has headphones in. It can’t hear the bells going off until they reach a deafening level; until it’s too late. However, when we’re aware of our anxiety, we’re able to self-soothe before the fire starts raging. We can calm ourselves down, helping the vagus nerve to send signals to our gut that we’re safe.
Self-awareness isn’t an intellectual, but an empathetic effort.
Sometimes we can think of self-awareness as a cold process similar to cartography. For example, if we could just chart out our anxieties we could keep them in control. The real process is much more emotional. Heinz Kohut describes the process of self-awareness as “empathic inquiry”. This means visualizing, leaning in, and coming close enough to the emotions for us to feel their pain. This is a difficult and sometimes scary process to encounter alone. Often we don’t have the perspective to see ourselves. Sometimes we are simply too defended against our own pain to really feel it.
Yet our brains are meant to heal with empathy. Remember those self-soothing frontal-lobe areas we mentioned earlier? (Orbital-frontal cortex and the anterior cingulate) Those pathways aren’t just there by default. When we’re very young, the empathy and soothing we receive by our caregivers become etched in our brains. These early interactions are the pathways that we rely on throughout life to self-soothe.
Your self-soothing ability can grow. When we increase our self-awareness, our empathy for our the anxious and unsafe feelings grow. That empathy is like a fire department that can respond to a fire with soothing water before it begins to rage.
3. Reduce Chronic Anxiety
It’s been demonstrated that even momentary times of calm and peace can be overshadowed and outweighed by stressors. When we’re exposed to a stress, or multiple stressors, the injection of cortisol into your system takes a while to subside. This is called allostatic load. The moments of deep breathing or mindfulness you practice throughout the day are important, but they sadly don’t outweigh the internal stress that can keep you in a high-cortisol state.
What’s the solution? Often the biggest stressors we carry are internal beliefs that impact our entire outlook on life. There is a relationship between early traumatic experiences and later IBS symptoms. This is because like a tea bag in hot water, our childhood experiences color and impact everything we experience. Resolving IBS means experiencing the relief of working through your anxiety. Anxiety is a signal that needs attention and understanding in order to resolve.
IBS and Anxiety: You can heal your gut
We have therapists who can help you reduce chronic anxiety. Identifying triggering foods is important, but can only get you so far. The stressor that most aggravates IBS is often not specific foods, but the chronic stress and anxiety that creates a fragile gut lining. Resolving and reducing anxiety physiologically allows your gut to repair the gut lining so you can be resilient.
Reducing anxiety impacts your everyday life. Not only does it help your gut, but helps your relationships, your job performance, your sleep, and your enjoyment of life. What would it be like for you to experience freedom from anxiety? How different would your day be today if you had more peace? We want to help you get there. Contact one of our therapists who specializes in anxiety. Schedule a free consultation and see how we can help you.
This client addressed anxiety to heal IBS issues:
My gut wrenched as I lifted myself from the bathroom floor. I looked in the mirror at my face. It was covered in hives. The hives went down my neck. I lifted my shirt to find my entire torso was covered in hot, red, itching hives. Internally, my stomach was tied in knots. What was happening to me? I had no history of allergies. I didn’t eat anything out of the ordinary. And yet I had just spent to last hour on the toilet.
I had traveled to the desert to facilitate a leadership retreat. I pulled up to the AirBnB where we would all be staying, set out the chips and guacamole, and people began arriving. That’s when my scalp started itching. I ignored that until I began to feel a stabbing pain in my stomach and ran to the bathroom. The people I was there to lead filled the time. Finally I mustered the strength to come out of the bathroom and ask for help. They ended up driving me to the emergency room.
When I returned home, my doctors were perplexed. The allergy tests, MRI’s, scopes, bloodwork and exams showed nothing.
Two months later, I traveled to visit family for Christmas. The night after our Christmas family dinner, I woke at 2am with hives and pain in my stomach so intense I lost consciousness. My family called an ambulance and I spent three days recovering in the hospital.
Over two years, this happened six times, all of them during a flight or visit with family. Finally, after numerous visits to doctors, I saw a therapist. Over the course of several months, we were able to explore each of these events. We began to pay attention to what my gut was signaling to me. It became clear that my body was dealing with anxiety that I had been repressing for years, anxiety I had become numb to.
Under the care of my therapist, I’ve been able to go on trips again without attacks. I am actually able to feel my anxiety now, rather than becoming crippled by it.
Today, I see my gut pain as one way that I can tell that I’m getting anxious. When my stomach begins to tighten up, I pay attention to what could be causing anxiety. In the past, my gut had to “shout” to get my attention that something was wrong. After therapy, my gut only has to tighten a little and I respond by caring for myself and asking for help.
– Anonymous Client