In our last blog, we went into detail about what stress is and what stress does to the body. If you missed that one, click here to check it out.
In this blog, we’ll dive deeper into how stress affects irritable bowel syndrome and inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis.
Let’s start by learning about what IBD and IBS are and how they develop. Then we will discuss what stress does to the body and how it affects gut health.
What are IBD and IBS?
IBD is a collective term for both Crohn’s disease (CD) and ulcerative colitis (UC). Both of these autoimmune diseases affect the digestive tract. They result in inflammation of the digestive mucosa, which can range from mild to severe enough to require hospitalization.
The big difference between CD and UC is the affected area. CD can cause inflammation of the entire digestive tract, while UC is generally isolated to the large intestine. But both can lead to inflammation throughout the entire body, manifesting as skin, eye, and heart conditions, and even liver and kidney problems (1).
Researchers are not entirely sure what causes IBD, but many risk factors have been identified.
- Genetics: Having a first-degree relative with IBD makes you 5 times more likely to develop the disease (1).
- Living in North America and Northern Europe: IBD is much more common in westernized countries than the rest of the world—about 1.2% of US adults have IBD. There are a number of reasons why this association exists. Differences in diet, toxin exposures, and even vitamin D deficiency are factors (1). Recently, IBD has also increased in developing countries in South America, Eastern Europe, Africa, and Asia (2). This is a big red flag that environmental and dietary factors may be at play (2).
- Early life antibiotic use, especially broad-spectrum antibiotics used 3 or more times (3).
- Psychosocial stress and feelings of depression (4).
Compared to IBD, IBS is much more common. It affects at least 20% of the general population (5). It is also a chronic disease, but there is no tissue damage, and it does not involve the immune system (5). Confusingly, inflammation is present in IBS, and the symptoms can be similar to those of an IBD—diarrhea, bloating, and abdominal pain. Sometimes someone with IBD will even be misdiagnosed with IBS (5).
Studies have shown an overlap between IBS and IBD, and those with IBD often also have IBS, especially those with Crohn’s disease (5). An extensive systematic review found that for those with IBD, the odds of having IBS was over 4 times greater than for someone without IBD (OR: 4.89 95 %CI 3.43 – 6.98).
Possible risk factors for IBS include:
- Being under the age of 50 (6)
- Female sex (6)
- Being a cigarette smoker (6)
- Psychosocial stress (6)
- History of use of broad-spectrum antibiotics, especially macrolide and tetracycline antibiotics (7)
What stress does to the body: It damages gut mucosa
When we look at triggers for the development of IBD and IBS, stress is a mutual risk factor. Another less understood but recognized commonality is the presence of intestinal hyperpermeability, informally known as “leaky gut.”
When we think about what stress does to the body, increased inflammation should be the first thing that comes to mind. Chronic inflammation is an insidious thing. It affects many organs and body systems. It affects how our cells function. And it affects the permeability of the gut.
High levels of inflammatory cytokines infiltrate the gut barrier when inflammation is present. These cytokines, along with the stress hormone cortisol, lead to a breakdown of the gut barrier, and leaky gut is the result.
Those with IBD have increased gut permeability, which allows microscopic proteins, bacteria, and other intestinal flotsam and jetsom to enter the bloodstream that should not be there. Eventually, the immune system gets wind of what’s happening and responds accordingly – with inflammation, and sometimes autoimmunity.
Many researchers think that hyperpermeability and damaged gut mucosa precede the onset of IBD and are key factors in developing IBD (8). An ongoing study called the GEM project (Genetic, Environmental, Microbial) found that healthy first-degree relatives of those with Crohn’s disease had increased intestinal hyperpermeability. These people would eventually develop Crohn’s disease themselves (9).
Some people with IBS may also have intestinal hyperpermeability. One study found that 39% of those with IBS also had leaky gut. This finding was the most prevalent in those with diarrhea dominant IBS, and it directly correlated to symptom severity. Those with IBS and leaky gut had an average symptom severity score of 100.8. The average symptom severity score for those with IBS without leaky gut was 51.6 (10).
So for those with IBD and IBS, stress and the resulting inflammation may be significant triggers of disease onset and are recognized as causative factors in disease flare-ups and severity of symptoms.
What stress does to the body: It affects the microbiota
Have you heard of gut dysbiosis? Dysbiosis happens when the microorganisms that live in our gut become imbalanced. A healthy and balanced microbiota provides a lot of health benefits for us.
But imbalanced microbiota can do just the opposite. Those with IBD and IBS often have dysbiosis. Although this is a relatively new area of study, there is growing evidence that dysbiosis plays a big part in the development of IBD and IBS (11).
Researchers have observed that people with IBD have less diverse gut microbes, less anti-inflammatory gut bacteria, and more inflammatory gut bacteria (11). One beneficial bacteria, Roseburia, was found to be significantly decreased not only in those with IBD but also in healthy folks with a strong genetic predisposition to develop IBD (11).
When dysbiosis is present, it directly affects the health of the gut. It can lead to a breakdown of the protective mucus layer, altered gut wall permeability, reduced growth of healthy new cells, and alter the immune system’s production of regulatory T cells (11). These are the cells that help prevent autoimmunity.
In a study of IBS patients undergoing fecal microbial transplant (the infamous poop transplant), those with IBS had significant dysbiosis at baseline. After a fecal transplant from subjects with healthy guts, their dysbiosis resolved, and their IBS symptoms significantly improved (12).
So what’s the connection between stress and our resident gut bacteria?
Stress affects the gut microbiota in many ways, all of which can lead to dysbiosis. In fact, some researchers think that stress itself is a direct cause of dysbiosis (13).
Remember that when we are in stress mode, it activates our sympathetic nervous system, our HPA axis, and our fight or flight response. This multi-system recruitment increases stress hormones like adrenaline and cortisol. It affects gut motility, increases leaky gut, and bombards us with oxidative stress and inflammation within the gut mucosa.
All of these can lead to dysbiosis. And, amazingly, simply allowing the gut bacteria to have direct exposure to stress hormones increases the overgrowth of harmful bacteria (13).
Bottom line: stress makes a mess of our microbiome.
What stress does to the body: It affects autophagy
Autophagy is the most astounding physiological process you might have never heard of.
It’s the self-regulatory process where old and misfolded proteins, old cells, and bad bacteria are broken down. This helps keep cells healthy and prevents disease and infection. It is essential for maintaining homeostasis within the gut.
Dysfunctional autophagy has been identified as a critical factor in the development of IBD (14). Too much autophagy means that too many cells are killed, which is problematic, and not enough autophagy means that malfunctioning proteins and old cells are hanging around, which is also not ideal. Both of these scenarios have been implicated in IBD (14).
Psychosocial stress ramps autophagy in the gut, making IBD worse (15). In our last blog, we talked about how corticotropin-releasing hormone (CRH) is released when we feel stressed. When this hormone is high, it increases autophagy within the gut. A 2019 study found that when mice with IBD were injected with CRH, intestinal inflammation and dysbiosis increased, worsening the severity of the disease (15).
How to counteract stress when you have IBS and IBD
Ok, so by now you are probably well aware that stress is bad, especially if you’re dealing with IBS and IBD.
But let’s be realistic—it’s basically impossible to avoid stress. However, we can manage how we respond to stress. Our previous blog provided simple tools you can use every day to help your body relax and get out of the sympathetic, fight-or-flight state. So be sure to read that here.
Now let’s talk about a few other ways to counteract stress when you have IBS or IBD.
Specific supplements and lifestyle changes are absolute game changers for the stress/IBS/IBD connection. While I am a big proponent of the food-first approach, supplements can sometimes come in handy.
Adaptogens are herbal supplements that balance your stress hormones. They include ashwagandha, rhodiola, ginseng, eleuthero, and cordyceps. They are wonderfully helpful when going through periods of chronic stress. Adaptogens also affect the immune system, so for those with autoimmunity, it is essential to work with a trusted practitioner to find the adaptogens that are right for you, especially as some are nightshades and those can be problematic for many with autoimmunity.
Certain probiotics can help reduce the negative effects of stress, especially gastrointestinal effects. One study found that taking a probiotic blend of Lactobacillus helveticus R0052 and Bifidobacterium longum R0175 during a period of chronic stress significantly reduced GI symptoms of abdominal pain, nausea, and vomiting (16). This probiotic combo can be found in Pure Encapsulations ProbioMood.
How probiotics affect those with IBD is still a new area of research, but many studies show beneficial effects of Bifidobacterium and Lactobacillus-based probiotics (17).
Antioxidants directly combat oxidative stress within the body that is caused by increased inflammation. You can get a lot of antioxidants from colorful plant foods, and you can boost your antioxidant status by supplementing with specific plants and herbs that provide extra antioxidants. The anti-inflammatory herbs boswellia, mastic gum, curcumin, wheatgrass juice*, and aloe vera have been shown to be effective at improving symptoms in those with IBD (17). Remember to always check with your health care team before adding any new supplements! Some supplements can interfere with medications or may not be appropriate for your specific scenario.
*Wheatgrass juice may not work for you if you are sensitive to wheat and/or gluten.
Our food choices can directly affect our physiological stress levels. Food quality is also vitally important for gut health and for those with IBD and IBS. For stress and gut health, limiting ultra-processed foods and added sugars is crucial. Instead, focusing on colorful plant foods, healthy protein, and healthy fat can help manage stress and support a balanced microbiome and robust intestinal barrier.
Avoiding or limiting intense exercise
Intense exercises like high-intensity training and long-distance running are major stressors. This type of stress is acute rather than chronic, so, in a healthy person, the body will recover quickly and gain benefit from the positive stress of the activity.
But for those who are already experiencing chronic stress or for those with gut inflammation, avoiding this type of acute stress is often part of healing. Try less intense forms of exercise until stress and inflammation have subsided, such as low-intensity cardio like walking, cooling, relaxing movements like swimming, or slow and steady weight lifting that promotes the parasympathetic (rest, digest, and heal) response.
If you want to deal with your IBS or IBD from a holistic, food-first perspective, The Good Poopers Club™ is the best way I know. It’s the program I wish I’d had when I was dealing with my ulcerative colitis diagnosis!