January 23, 2020
Gut Health
How IBS and Anxiety Are Interconnected
You’ve likely experienced stress and digestive disorders together throughout your life. For example, have you ever gotten a stomach ache before a big presentation, or experienced irregular bowel movements before or after a difficult conversation? The answer is likely yes. So it’s not a stretch of the imagination to see how anxiety and IBS may be related. Before we examine this connection, let’s get on the same page about what IBS and anxiety are.
IBS, or irritable bowel syndrome, is a chronic condition of the digestive system that affects up to 22% of the population (1). Common IBS symptoms include bloating, abdominal pain or discomfort like cramping, and changed bowel habits like constipation or diarrhea (1). Unlike Crohn's disease and ulcerative colitis, there's nothing wrong with the physical structure of the GI tract in those with IBS. Researchers do not yet know the exact cause of IBS, but there's an understanding that IBS is associated with psychological factors. According to researchers, “traumatic life events such as early maternal separation and sexual abuse have been found to play an important role in the subsequent development of IBS” (1). The link between anxiety and IBS has also been examined.
Let’s clarify what we mean by anxiety. There are five main types of anxiety disorders: generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and social phobia or social anxiety disorder (2). No matter which type of anxiety you have, it's characterized by persistent, excessive worrying and can be accompanied by physical symptoms like increased heart rate, dizziness, and chest pain (2). Approximately 18% of adults in the United States suffer from anxiety (3). According to researchers, “the prevalence of psychiatric conditions in IBS ranges from 40% to 100%” (1). However, there are varying reports on the prevalence of anxiety in particular. The current results are contradictory. Some studies have reported “elevated levels of anxiety and depression in IBS compared to healthy controls," while other studies haven't found this connection (1). While the science is still developing, anecdotally many individuals suffer from both IBS and anxiety. To understand the potential link between the two, we'll examine how anxiety impacts digestion.
Your brain and your gut are connected and can communicate with one another via the gut-brain axis. This is a series of “neural, hormonal, and immunological” lines of communication by which the brain can influence the gastrointestinal tract and vice versa (4). Essentially, they can speak to each other. Scientists speculate that anxiety stimulates the body to release a cascade of stress hormones, including corticotropin-releasing factor (CRF), which then increases gut sensitivity, stimulates the immune system, and alters the gut microbiome (4). This can result in altered bowel movements and other symptoms common in IBS, such as abdominal pain and bloating. But anxiety doesn’t have to come before gut dysbiosis. According to Marlynn Wei of Psychology Today, “one study found that having an intestinal infection is associated with an increased risk of developing an anxiety disorder over the next two years” (5). In this study, dysbiosis preceded the development of anxiety. This association between anxiety and the gut microbiome has led researchers to turn to probiotics as a potential solution. Currently, there are promising results for one species in particular, Lactobacillus (L.) rhamnosus. Marlynn says “Lactobacillus (L.) rhamnosus has the most evidence showing that it could significantly reduce anxiety” (5). More research is needed to truly confirm the potential of probiotics in treating anxiety. So what comes first: anxiety, IBS, or dysbiosis? As of now, scientists are unsure. This psychological approach to IBS is promising. However, the scientific community needs to conduct further research on the role of the gut-brain axis in IBS and anxiety to fully understand the connection.
According to researchers, as many as 80% of people with IBS also experience at least one psychological disorder, such as anxiety or depression, with the typical range between 40-60% (6). Studies show that many people with IBS report a major life trauma before the onset of their symptoms. This trauma can range from a marriage ending to a boyfriend leaving to the loss of a family member. Furthermore, researchers found that “stressful life events can exacerbate abdominal pain and abdominal distension in up to one-third of IBS patients” (6). Stress, like the stress that comes from chronic feelings of anxiety, can influence IBS symptoms by reducing intestinal blood flow, increasing intestinal permeability, activating the immune system, and increasing inflammation (6). (Increased intestinal permeability can also result in leaky gut, which is connected to IBS.) It’s important to note that anxiety is just one risk factor for IBS. Other risk factors include being female, being between the ages of 13-40, having a family history of IBS, and having food sensitivities (7).
IBS treatment is currently focused on managing IBS patients’ symptoms to increase their quality of life. Pharmacological options include laxatives, anti-diarrheal medications, antidepressants, and more. However, these don’t work for everyone and rarely provide permanent relief. Therefore, non-pharmacological options are being explored, one of which is managing stress. Cognitive behavioral therapy and hypnotherapy have both been proposed as treatment options for people struggling with IBS and anxiety. These therapies are intended to reduce stress and hopefully alleviate symptoms (6). In order to cope with stress, you may also wish to begin meditation, yoga, deep breathing, or another stress-alleviating activity. Joining an IBS support group is another great way to manage stress by talking about your experience with those who understand what you’re going through. Modifying your diet to avoid trigger foods and increase fiber, exercising regularly, and getting enough sleep are also recommended as methods of managing IBS symptoms. You may wish to work with a dietician to eliminate high-gas foods such as carbonated drinks, caffeine, alcohol, raw fruit, cabbage, broccoli, and cauliflower, as well as gluten and FODMAPs (8). The acronym FODMAP stands for the types of small carbs many people have a difficult time digesting: "fermentable oligo-, di-, mono-saccharides, and polyols" (8).
IBS is characterized by gastrointestinal changes such as bloating, abdominal pain or discomfort, and changed bowel habits such as constipation or diarrhea. It affects over one-fifth of the population and many people with IBS also suffer from psychiatric disorders such as anxiety and depression. The gut-brain barrier allows the gut and brain to communicate with one another and may be partially responsible for the link between IBS and anxiety. It's unclear whether IBS leads to anxiety or vice versa, but both are associated with an altered gut microbiome. Many people with IBS experience a major life trauma before the onset of their symptoms, making scientists speculate on how stress can exacerbate IBS symptoms. Anxiety can influence IBS symptoms by reducing intestinal blood flow, increasing intestinal permeability, activating the immune system, and increasing inflammation. When it comes to managing your IBS symptoms, non-pharmacological approaches can help you manage your stress and reduce anxiety. This can include cognitive behavioral therapy, hypnotherapy, meditation, yoga, support groups, a healthy diet, regular exercise, and a consistent sleep schedule. There are pharmacological treatment options as well. However, they do not work for everyone and often do not provide lasting relief. The bottom line: there is no clear answer to whether IBS causes anxiety or vice versa. Many factors are at play in both anxiety and IBS, and one cannot be scientifically proven to be the cause of the other at this time. If you are concerned about your IBS symptoms or anxiety, consult your healthcare provider. As a friendly reminder, we're not doctors and this information does not constitute medical advice. If you're ready to take control of your digestive and mental health, sign up for our email list, and receive exclusive health tips we don't share with the public.
What Is IBS?
What Is Anxiety?
How Are Anxiety and IBS Connected?
Your brain and your gut are connected and can communicate with one another via the gut-brain axis. This is a series of “neural, hormonal, and immunological” lines of communication by which the brain can influence the gastrointestinal tract and vice versa (4). Essentially, they can speak to each other. Scientists speculate that anxiety stimulates the body to release a cascade of stress hormones, including corticotropin-releasing factor (CRF), which then increases gut sensitivity, stimulates the immune system, and alters the gut microbiome (4). This can result in altered bowel movements and other symptoms common in IBS, such as abdominal pain and bloating. But anxiety doesn’t have to come before gut dysbiosis. According to Marlynn Wei of Psychology Today, “one study found that having an intestinal infection is associated with an increased risk of developing an anxiety disorder over the next two years” (5). In this study, dysbiosis preceded the development of anxiety. This association between anxiety and the gut microbiome has led researchers to turn to probiotics as a potential solution. Currently, there are promising results for one species in particular, Lactobacillus (L.) rhamnosus. Marlynn says “Lactobacillus (L.) rhamnosus has the most evidence showing that it could significantly reduce anxiety” (5). More research is needed to truly confirm the potential of probiotics in treating anxiety. So what comes first: anxiety, IBS, or dysbiosis? As of now, scientists are unsure. This psychological approach to IBS is promising. However, the scientific community needs to conduct further research on the role of the gut-brain axis in IBS and anxiety to fully understand the connection.
How Anxiety Can Make Your IBS Symptoms Worse
According to researchers, as many as 80% of people with IBS also experience at least one psychological disorder, such as anxiety or depression, with the typical range between 40-60% (6). Studies show that many people with IBS report a major life trauma before the onset of their symptoms. This trauma can range from a marriage ending to a boyfriend leaving to the loss of a family member. Furthermore, researchers found that “stressful life events can exacerbate abdominal pain and abdominal distension in up to one-third of IBS patients” (6). Stress, like the stress that comes from chronic feelings of anxiety, can influence IBS symptoms by reducing intestinal blood flow, increasing intestinal permeability, activating the immune system, and increasing inflammation (6). (Increased intestinal permeability can also result in leaky gut, which is connected to IBS.) It’s important to note that anxiety is just one risk factor for IBS. Other risk factors include being female, being between the ages of 13-40, having a family history of IBS, and having food sensitivities (7).
How to Manage Your Anxiety to Reduce Your IBS Symptoms
IBS treatment is currently focused on managing IBS patients’ symptoms to increase their quality of life. Pharmacological options include laxatives, anti-diarrheal medications, antidepressants, and more. However, these don’t work for everyone and rarely provide permanent relief. Therefore, non-pharmacological options are being explored, one of which is managing stress. Cognitive behavioral therapy and hypnotherapy have both been proposed as treatment options for people struggling with IBS and anxiety. These therapies are intended to reduce stress and hopefully alleviate symptoms (6). In order to cope with stress, you may also wish to begin meditation, yoga, deep breathing, or another stress-alleviating activity. Joining an IBS support group is another great way to manage stress by talking about your experience with those who understand what you’re going through. Modifying your diet to avoid trigger foods and increase fiber, exercising regularly, and getting enough sleep are also recommended as methods of managing IBS symptoms. You may wish to work with a dietician to eliminate high-gas foods such as carbonated drinks, caffeine, alcohol, raw fruit, cabbage, broccoli, and cauliflower, as well as gluten and FODMAPs (8). The acronym FODMAP stands for the types of small carbs many people have a difficult time digesting: "fermentable oligo-, di-, mono-saccharides, and polyols" (8).
IBS and Anxiety: The Bottom Line
IBS is characterized by gastrointestinal changes such as bloating, abdominal pain or discomfort, and changed bowel habits such as constipation or diarrhea. It affects over one-fifth of the population and many people with IBS also suffer from psychiatric disorders such as anxiety and depression. The gut-brain barrier allows the gut and brain to communicate with one another and may be partially responsible for the link between IBS and anxiety. It's unclear whether IBS leads to anxiety or vice versa, but both are associated with an altered gut microbiome. Many people with IBS experience a major life trauma before the onset of their symptoms, making scientists speculate on how stress can exacerbate IBS symptoms. Anxiety can influence IBS symptoms by reducing intestinal blood flow, increasing intestinal permeability, activating the immune system, and increasing inflammation. When it comes to managing your IBS symptoms, non-pharmacological approaches can help you manage your stress and reduce anxiety. This can include cognitive behavioral therapy, hypnotherapy, meditation, yoga, support groups, a healthy diet, regular exercise, and a consistent sleep schedule. There are pharmacological treatment options as well. However, they do not work for everyone and often do not provide lasting relief. The bottom line: there is no clear answer to whether IBS causes anxiety or vice versa. Many factors are at play in both anxiety and IBS, and one cannot be scientifically proven to be the cause of the other at this time. If you are concerned about your IBS symptoms or anxiety, consult your healthcare provider. As a friendly reminder, we're not doctors and this information does not constitute medical advice. If you're ready to take control of your digestive and mental health, sign up for our email list, and receive exclusive health tips we don't share with the public.
Fact checked by Carla Cargano on 01/23/2020 and written by Carla Gargano
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