The Stress and Gut Health Connection

Janet Tiberian Author
By Janet Tiberian, MA, MPH, CHES
June 16, 2023
Man holding his stomach in pain

Have you ever gotten a stomachache when you’ve been nervous or stressed? It’s that awful queasy feeling that creeps up when you’re facing a deadline, getting ready for a presentation or taking a test. And while these stomachaches usually pass quickly, they show a connection between stress and gut health.

When you’re stressed, your body triggers a stress response, which may impede blood flow to the digestive tract and upset the stomach. This can cause cramping, inflammation and an imbalance in your gut microbiome, the trillions of microorganisms which help regulate many systems in your body. Regular stress can contribute to the development of longer-term conditions like ulcers and irritable bowel syndrome. 

But stress and nervousness are not the only emotions that can wear on our gut. Anger, sadness and excitement also can take on toll on your gut health, as can mental health conditions such as anxiety and depression. 

The connection is the result of the gut-brain axis. This two-way communication network links the central (CNS) and enteric nervous systems (ENS). You’re probably familiar with the central nervous system, comprised of the brain and spinal cord, it takes in sensory information, processes information and sends motor signals.

The lesser-known enteric nervous system is made up of nerves, neurons and neurotransmitters that travel along the digestive tract, starting with the esophagus and extending through the stomach, small and large intestines, rectum and anus. 

It’s often referred to as our second brain because of its ability to communicate with the CNS, particularly the emotional and cognitive centers of the brain. As a result, the connection affects our physical and mental health. Moreover, studies have found that our gut microbiota influences these interactions, explaining the link between gut microbiota and mental health, including stress.

But stress isn’t just about triggering an upset stomach. It also plays a role in chronic gastrointestinal conditions.

Stress and Gastrointestinal Conditions

Stress slows blood flow to the digestive system which can upset your stomach and cause symptoms of gastrointestinal distress. But more importantly, it can contribute to a handful of conditions.

Gastroesophageal Reflux Disease (GERD) occurs when stomach acid backflows into the esophagus, the tube that connects the mouth and stomach. This backwash or acid reflux irritates the esophageal lining. Everyone experiences acid reflux occasionally, but when it becomes chronic, it’s considered gastroesophageal reflux disease (GERD). Long-term GERD can cause problems such as swallowing, coughing and throat irritations. It can even exacerbate asthma. Treatments usually involve medication. And it’s important to manage stress as it increases acid production in the stomach, perpetuating GERD.

Inflammatory Bowel Disease (IBD) is an umbrella term for Crohn’s disease and ulcerative colitis -- conditions that trigger chronic inflammation of the gastrointestinal tract because of an immune system that improperly responds to viruses and bacteria. Long-term GI inflammation can lead to bone loss and permanently tissue damage, raising the risk for colorectal cancer, intestinal strictures (narrowing of the gastrointestinal tract), fistulas and abscesses. Treatments involves lowering inflammation via medications, nutritional support, lifestyle changes and surgery. Maintaining mental health is of upmost importance in controlling IDB, as some studies link relapses to chronic stress and depression.

Irritable Bowel Syndrome (IBS) produces symptoms of gastrointestinal distress. Unlike IBD, IBS doesn’t damage tissue. Although the exact cause is unknown, it seems to be linked to factors such as: 

  • Stronger and/or weaker than normal intestine contractions 
  • Poor coordinated signals between brain and intestines
  • Infections such as gastroenteritis (a bacterial or viral infection of intestines); or overgrowth of bacteria, especially if stress was poorly managed prior to the infection. 
  • Gut microbe changes 
  • Stressful events, particularly during childhood 

Treatment varies based on what’s triggering the symptoms. Keeping a diary can help you figure out what’s setting off your symptoms. Most times, it will be related to stress. Regardless of your specific triggers, if you eat more homemade foods and less processed or restaurant made foods, get exercise and manage stress, your symptoms may be easier to control. Your doctor can help you with treatment.

Peptic ulcers occur when a bacterial infection caused by Helicobacter pylori weakens the protective lining of the esophagus, stomach and duodenum (first section of the small intestine), enabling gastric acid to penetrate the lining beneath the stomach and duodenum. The bacteria, often referred to as H. pylori, and acid irritate and wear the lining, causing a sore or ulcer. Medications, particularly antibiotics, proton pump inhibitors and some over-the-counter heartburn medications are used to treat and heal the lining. Your doctor also may suggest you manage stress, as it’s been found to inflames the stomach lining, contributing to the formation of peptic ulcers.   

For more information on stress and your gut health, talk to your primary care doctor. If you don’t have a primary care physician, consider partnering with an MDVIP-affiliated doctor. They can customize a wellness plan for you that includes stress management. Find an MDVIP affiliate near you and begin your partnership in health »

About the Author
Janet Tiberian Author
Janet Tiberian, MA, MPH, CHES

Janet Tiberian is MDVIP's health educator. She has more than 25 years experience in chronic disease prevention and therapeutic exercise.

View All Posts By Janet Tiberian, MA, MPH, CHES
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