Anxiety and IBS are ruining your life? Well, it’s hard to live with symptoms like constipation, diarrhea, abdominal pain (like having a knife through your intestines) and bloating (debilitating, you feel sluggish and fat) on top of the everyday anxiety. Health-related quality of life is lower in patients with IBS compared with patients with other chronic health problems (Wilson et al, 2004) and with these symptoms there is no wonder why.
The connection between anxiety and IBS is painfully real. The good news is that any treatment that eases the symptoms on one will have direct or indirect influence over the symptoms of the other one.
You may have heard before about the link between your brain and your gut. But they are wonderfully connected. Let’s see how.
The Link Between Gut and Brain – a Bidirectional Communication
In order to understand how anxiety and IBS affect one another, we must look at the connection between mind and body.
Your body is made of interconnected systems and the brain is the supercomputer that supervises them all. Your brain makes sure that all interactions are ok. When all the parts of your body interact harmoniously you feel good, you experience good health.
The gut (the digestive system) and the brain (the nervous system) lie at the foundation of our physical and mental health! And the connection between these two is not a myth but a ‘biological fact’ (Mayer, 2016).
Your gut is not just a machine that processes your food. It is an amazing little ‘brain’ that has sensors that encode the information that comes from your food. Once the gut processes this information, it sends a feedback to the brain via ‘gut sensations’ (Mayer, 2016). The brain sends signals back to the gut to adjust its function via ‘gut reactions’.
When you are stressed or anxious, your gut reacts differently from the times when you are relaxed. Anxiety disrupts the communication from gut to brain and from brain to gut.
The Gut Microbiome – the More the Merrier
The microbiome completes the communication between gut and brain. Thus, we don’t just talk about gut and brain, but gut-microbiome-brain axis.
First, the microbiome links your mental wellbeing to your food and then the processing of your food influences your mental and emotional state. For example, if you are having dinner and during this time you are having a powerful argument with someone, you get angry. Then this state of anger influences how your brain communicates with your gut, slowing down your digestion. Spastic contractions take place that do not allow your stomach to process the food. Your inhibited digestion will affect your mood over the course of your day.
The microbiome is the trillions of microorganisms, called microbes that live in your body. The more diverse is your microbiome, the better. A proper balance of microbes is important for your mental health.
Children who have a low diversity of microbiome during the first years of life are predisposed to anxiety and even autism (Mayer, 2016).
Diversity of your microbiome helps the communication between brain and gut remain stable. Also, it makes your body more resilient to sickness or trauma.
Why Chronic Stress is Harmful for Your Gut-Brain Communication
Stress and anxiety alter the system that normally keeps everything together. Our brain perceives stress as a threat. And after all, stress can be useful when there is an external threat that puts your life in danger (e.g. you are running and encounter a not so friendly dog). But your body perceives as a threat also a challenging meeting, a tough conversation with someone or a demanding deadline.
Once your brain acknowledges the ‘threat’ it activates the stress program in the brain. This means it will organize certain responses in our bodies so it can fight the threat. The brain will activate what Dr Mayer called ‘the stress master switch’, a signaling molecule that reaches the amygdala which triggers the feeling of anxiety and fear. And from here follows heart palpitations, sweaty palms, and the urge to eliminate any contents from the gastrointestinal tract.
Stress (like anger, fear or sorrow) only becomes harmful when it is chronic. This is because not only changes the way your brain communicates with your gut but also alters the composition of the microbiome. Not to mention that this constant fight-or-flight system with elevated stress hormones circulating through our bodies can lead to anxiety disorders and depression.
When you have IBS, your gut is hypersensitive to stress. Normal gut activity can cause abdominal pain, cramping, and visible bloating of the stomach. This means that you will experience stress-induced symptoms all the time.
How to Cope With Anxiety and IBS
Your food choice plays a big part in how successful you are in dealing with anxiety and IBS. For example, people with IBS report that diets high in carbohydrates, fatty foods, coffee, alcohol, and hot spices worsen their symptoms (Gibson and Shepherd, 2012). So what are key changes in your diet that will benefit both your mind and gut?
Probiotics / fermented foods
Eating fermented foods and taking probiotics help anxiety-prone individuals reduce their anxiety. Some studies performed in mice observed a decrease in anxiety-like behavior when they fed the probiotic Lactobacillus rhamnosus to healthy adult mice (Mayer 2016). Also, good microbes such as lactobacilli and bifidobacteria from fermented foods (kimchi, sauerkraut, some cheeses), yogurts, kefir or in probiotic capsules improve the diversity of the gut microbiome.
Cut Fat and Sugar
Healthy food produces good microbes. A good place to start with building a healthy microbiome is eliminating sugar and processed food and eating a clean diet. A plant-based diet will help your body to produce a more diverse microbiome. Also, cut animal fat. Patients with IBS report abdominal bloating after having a large fatty meal (Gibson and Shepherd, 2012).
Avoid processed foods. Buy only things in the market that look like food. Target only foods with a maximum of 5 ingredients. If they have over 5 ingredients more probably they are highly processed.
Because Mediterranean diet contains a minimal number of foods that trigger gastrointestinal symptoms, it represents a therapeutic dietary change for those who suffer from anxiety and IBS. For example, fats provide less than 35% of total calories. (Castro-Quezada et al., 2014).
A typical Mediterranean diet contains at least
5 servings of vegetables
1–2 servings of legumes and beans
3 servings of fruit
3–5 servings of grains
5 servings of plant fats (olive oil, avocado, nuts, and seeds),
seafood 2–4 times per week
red meat only 1 time per week
low-fat dairy products
moderate amounts of red wine
Fasting: Risky or Beneficial for Your Gut?
Fasting may be beneficial for the gut and the body by eliminating toxic substances. Dr Mayer also says that fasting may influence the composition and function of your gut microbiome and possibly on your brain. Still, further studies are needed in order to determine how fasting helps people with anxiety and IBS.
Researchers in Japan carried out a study to see how beneficial is fasting on people suffering from IBS. They split the individuals in two groups: 36 people did fasting therapy for 10 days, while 22 followed a treatment that included medication and psychotherapy. Fasting improved 7 out of the 10 symptoms assessed; abdominal pain-discomfort, bloating, diarrhea, anorexia, nausea, anxiety, and interference with daily life. Still, the individual received closed medical attention, and they received alternative IV nutrition.
You can fast in three ways :
Eat every other day and fast on the alternate days
Consume the usual number of calories five days and only consume 500-600 calories on two non-consecutive days each week.
Only eat within a specified time window. (e.g. 16/8 fast, when you only eat between the hours of 12pm and 8pm). The easier alternative is the overnight fast when you fast for 12 hours at night after dinner.
Dietitians do not support the fasting treatment. Fasting may be risky if the IBS symptoms are hard to keep under control. This is because irregular eating or skipping meals usually aggravates the IBS. Still, some other persons say fasting helped them.
Personally, fasting did not work for me. In the beginning felt nice, but then I would always starve during the time designated for meals and I would eat too much and get bloated, with excruciating abdominal pains.
When stubborn symptoms of IBS won’t go away with standard medical treatment, doctors support the idea of psychological interventions. These are important because you target both anxiety and IBS.
CBT or Other Therapies
By easing anxiety symptoms, you will ease your IBS pains as well.
CBT for example, focuses on changing your behaviours and your dysfunctional thought patterns in order to improve your mood and IBS symptoms. Besides the classic CBT techniques (challenging your thoughts, deep breathing or relaxation exercises) this type of therapy helps you increase awareness. You start to notice how stress and anxious thoughts generate IBS symptoms and how IBS problems affect your mood. You start to see how this brain-gut axis mentioned earlier in this article is affecting your daily life.
CBT is very popular, but researchers say that the improvements are usually short term.
Give your digestive system a change to rest and digest. Researchers found that meditation can provide lasting relief from the most unpleasant IBS symptoms like bloating and abdominal pain (Keefer, 2002).
Studies suggest that hypnotherapy is another mind-body intervention that can help you treat your IBS. Several studies showed improvements also on anxiety, depression, quality of life and disability. (Kearney and Chang, 2008). A study in UK found that hypnotherapy is more efficient that psychotherapy (Whorwell et al, 1984).
There is a type of medical hypnosis called gut-directed hypnotherapy that can provide relief.
Changing your diet is not enough. You need to change your lifestyle as well.
Don’t eat large meals when you are stressed, angry, or sad
Before eating, scan your body and mind and tune in to your emotions. If you are stressed, anxious, or angry, try to avoid adding much food to the turmoil in your gut. Your negative emotions affect the ‘behaviour’ of your gut microbiome. This will affect the way microbes break down food and what information they send back to the brain. The signals they will send won’t be ‘happy signals’. As a result, your mood will not improve. Then you will feel again negative emotions which will affect your digestion again, and your gut will send signals back to the brain. This cycle can go for a long time, unless interrupted by an intervention like meditation to calm down.
Results of a study done on 683 patients with IBS suggested that exercise had significant benefits. The exercise interventions in this review were yoga, walking/aerobic physical activity, Tai Ji, mountaineering, and Baduanjin qigong activity. The benefits of exercise may be particularly efficient for those who suffer from constipation. Exercise can improve feelings and symptoms of fatigue, bloating and even abdominal pain. Not only exercise eases IBS symptoms but also helps you manage anxiety.
Can anxiety cause irritable bowel syndrome? Can IBS give you anxiety? These are questions that researchers are yet to provide firm answers. Further studies will have to be done.
Still, your brain and your gut are related, and they influence each other. What affects your mind can affect your gut and vice versa.
Please remember that there is no simple, magical cure such as X diet. You need to look at the influence of gut reactions associated with stress, anger, and anxiety.
And you cannot do one thing and expect miracles. Simply eating probiotic yogurt while continuing your high-animal-fat, low-plant-food diet, trying out kimchi or sauerkraut for a short period, or eliminating gluten from your diet will not help on the long run.
Have a little audit with yourself. What behaviours or daily actions affect your mind? Are you always under stress? How do you manage your anxiety? What emotions do you have?
Then look at your diet. Are you eating mostly packed, refined foods? How much animal fat you have daily? Sugar, how many sweets and cakes do you have? Even if you are active and workout three times a week or you run regularly, if your diet is poor it will contribute to your anxiety and IBS symptoms.
As much as I don’t enjoy using this word, but your approach should be ‘holistic’. Also, it will be unique. Your lifestyle and environment differ from everyone else’s.