Have you been told that stress is causing your IBS, SIBO or Functional Dyspepsia symptoms?

Have you been told that stress is causing your gut symptoms?

Have you been told to ‘try these anti-depressants’? Or that you are ‘completely normal’ and are ‘obsessing’ over your symptoms. Or maybe that you’re imagining them entirely? But you KNOW that the pain is VERY real, as is the urgency to find a toilet, the acid rising in your throat, the belching, the awful constipation…

I was told it was all in my head.

I remember it so well. Breaking down at yet another doctor’s appointment having been told that the crippling pain I felt 24/7 was caused by my ‘negative attitude’. Another doctor telling me that ‘I seemed very anxious.’ WELL OBVIOUSLY! Years of pain, worsened by every drug they tried - it got to the point where even the thought of speaking to a doctor was enough to have me crying in panic. I left that very appointment with yet another antidepressant prescription and told I should try yoga classes.

It was very obvious to me, as for so many others, that my gut symptoms started at really stressful time. So does that mean that my doctor was right?!

Well, yes and no.

Does stress cause gut symptoms?

Symptoms of IBS, SIBO and Functional Dyspepsia themselves are not caused by stress. They are caused by underlying factors such as poor motility, poor immune function in the gut, gastritis, poor digestive capacity and dysregulation (dysbiosis) of the gut microbiome [1]. These factors, in turn, CAN be caused by stress.

Simply addressing stress alone (booking that yoga class, reading a book, learning an instrument etc) can result in huge improvements and is a critical part of gut repair. In fact, I would argue it is impossible to heal your gut without managing your stress.

For many people, however, all of the de-stressing activities in the world aren’t enough to make a dent on symptoms, and instead begin a cycle of frustration - you are now doing ‘all of the right things’ and STILL nothing is improving.

Most of the time, these underlying causes (which may or may not have been caused by stress in the first place), also need dealing with before progress can be seen.

How does stress cause IBS, SIBO and Functional Dyspepsia symptoms?

The answer lies in the balance between our parasympathetic and sympathetic nervous systems, or ‘rest and digest’ vs ‘fight or flight’.

Our fight or flight response is responsible for helping us to run away from a tiger - if we were being chased by a tiger, our body would not be wasting any energy on digestion, instead using all of that energy helping us to run away as quickly as possible.

Prowling tiger representing a danger for our fight or flight response

Fight or flight causes release of the hormones cortisol, adrenaline and noradrenaline, which has the following effect on our gut:

Reduced gut blood flow (can increase intestinal permeability) [2]
Reduced gut motility (peristalsis and migrating motor complex activity)
Reduced digestive secretions - stomach acid, enzymes and bile
Increased microbiome dysregulation with more pathogens
Increased pain perception [3]
Reduced gut immune function (decreases secretory IgA) [4]
Increased blood glucose and reduced insulin (affecting nerve function) [5]

Our nervous systems haven’t really kept up with modern living, so when we get stressed, we don’t differentiate between the stress caused by running late for work, with the stress caused by really being chased by a tiger.

And here’s the thing, we need some stress - it’s healthy. The problem is the constant, underlying level of stress we find ourselves with today, leading to more constant digestive shut downs.

Additionally, many with gut symptoms find themselves on incredibly restrictive diets, and I think these are a hugely overlooked source of stress. For those with SIBO, there is often a huge fear of ‘feeding the SIBO’ (fake news![6]), and this sustained level of stress will contribute to symptoms.

Specific diets can SOMETIMES be helpful for short periods of time (2-4 weeks max), but any longer than this can cause further negative changes to your microbiome, as well as depleting your essential vitamin and mineral stores. This is on top of the stress of merely trying to live your life with such intense restrictions.

How does dysbiosis cause stress to the body?

Stress causes dysbiosis, but dysbiosis can also cause stress.

The gut and brain are in constant communication, and research demonstrates that a dysregulated microbiome is involved in the development of mental health problems such as depression [7].

This is likely due to the body releasing inflammatory mediators in response to the dysbiosis. These inflammatory mediators then drive neuroinflammation [8].

A study has shown that the shifts in the microbiota caused by a high fat diet can contribute towards increased levels of anxiety [9]. This is particularly interesting the the holistic gut health space where there is often an emphasis placed on low carb/high fat diets for the treatment of IBS, SIBO and Functional Dyspepsia.

Conversely, increased Bifidobacterium and Lactobacillus levels decrease anxiety and physiological distress [10]. These microbes need fibre to survive - the nutrient so often first to vanish from the diets of those suffering from gut symptoms.

All of this points to the need to address brain and body simultaneously to see results.

How can I reduce my stress levels?

I was rubbish at stress management. I thought I was doing it really successfully when I put aside 15 mins of my day for meditation, during which time I almost exclusively wondered when the 15 mins would be ending.

I realised that for me it was more about ‘doing it right’ (a perfectionist approach) and it felt so much harder than ‘taking a tablet and getting better’. I utilised a brain retraining programme (more below) to help me change my mindset surrounding health and healing. It also made me realise that the goal is not to remove all stress from my life (impossible), but to improve my resilience to it.

Here are some techniques that helped me reduce my stress levels.

1. Brain retraining programmes

I used Vital-Side (other well known programmes include DNRS and the Gupta program) and it made a huge difference to me.

It is a brain retraining programme focussing calming your fight or flight response and reducing inflammation [11]. It was a real turning point for me, and was when all of my other interventions suddenly started working. I would absolutely recommend this for people who have had gut symptoms for a long time.

2. Visualisation

As children, we spent hours daydreaming. In adulthood, this time is often replaced by screens and a never ending to-do list. I loved taking the time to really imagine my best life - practising visualising myself ‘healed’ daily and what that would look like for me. Being someone who struggles with meditation, my brain liked to have something really tangible to focus on [12].

3. EFT

A brilliant quick tool for dealing with stress in the moment [13]. It requires no special knowledge or technique, and can be done anywhere. I do it until I yawn - a good sign the body has moved back into a parasympathetic state [14].

4. Somatic movement

Another modality that makes me yawn! Somatic movement is movement that really connects your brain and body on a deep level - I think of it like a moving meditation. I love the slowness and curiosity behind each movement, but also the focus required to make it really mindful. It has been shown to be helpful for PTSD [15].

5. Deep breathing

There are lots of ways of doing this, and it may take some experimentation to find out what you prefer.

Personally, box breathing is my favourite breathwork technique. It is such a quick and easy way to get your body back in a parasympathetic (rest and digest) state [16], and particularly helpful to do a few rounds immediately before eating. Other options include alternate nostril breathing and 4-7-8 breathing.

6. Reading

I have always loved reading but noticed I was doing it less as life got in the way. I make a very conscious effort to make some reading part of my day every day, and my nervous system loves it. It also feels like such a treat to be able to carve out this time away from my phone and emails.

If reading isn't your thing, try another hobby or activity you enjoy instead!

7. Time away from screens

Screens have been demonstrated to cause stress [17], so anything you can do to get away from screen time will help your gut symptoms in the long run.

Blue light emitted from screens, particularly close to bedtime, has been shown to disrupt our circadian rhythm and cause sleep issues [18]. I like to keep my phone on ‘night shift’ mode, particularly if I need to use my phone within a couple of hours of bed.

It’s a great idea to spend your screen down-time in nature - there is so much research linking time in nature to stress relief [19]. It can be as simple as getting outside first thing in the morning, walking on the grass barefoot, some gardening, anything…but leave your phone indoors!

8. Get a pet!

Shown to reduce stress levels [20] (no surprise to anyone with a pet!), but also shown to cause beneficial changes in their owners microbiome [21]. They can also provide friendship at a time where many with IBS, SIBO and Functional Dyspepsia feel isolated due to their symptoms.

9. Losing dietary restrictions

This one was huge for me. I was literally eating 3 foods (chicken, rice and carrots) and STILL having horrible symptoms, but I was so scared of ‘feeding the SIBO’ that I didn’t realise my diet was keeping me stuck. In fact, I only started noticing any improvements when I started expanding my diet significantly, and notably, increasing my fibre intake.

Gut symptoms come with a side order of food fear in so many, and working to manage and overcome this is absolutely crucial for gut repair.

10. More time with friends

It’s so easy to isolate yourself when you’re suffering with IBS, SIBO or Functional Dyspepsia. Eating out feels impossible, and all you can think about is your symptoms.

This obsession with healing can actually hold you back and keep you stuck in a fight-or-flight response. Make time for friends, connection, laughter and play to help your body naturally find that rest-and-digest state.

To sum up:

Relaxing should not be stressful! If you feel stressed about trying to fit one of these into your day, then maybe it isn’t the right thing for you. You should not spend your relaxation time counting down the minutes until you can tick it off the list for the day!

And remember, don’t expect miracles. You won’t start one of these techniques and immediately feel better, but if you can layer these brain-based stress reduction techniques on to other, body and biome-focused strategies, you will be giving your body the tools it needs to heal.

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