Stressed out? Turns out anxiety can mess with your gut—big time.

By Julia Malacoff
April 05, 2018
Photo: Leszek Glasner / Shutterstock

It's pretty much accepted these days that in many cases, mental health and physical health are one and the same. Mental health issues have been linked to conditions such as heart disease, diabetes, and even autoimmune diseases like psoriasis, which means that if you care about your physical health, you should *definitely* pay attention to what's going on inside your head, too. Another area that's inextricably linked to your thoughts and feelings? Your digestion. Ever notice that when you're feeling upset, anxious, or overwhelmed, things are just a little ~off~ with your GI tract? Turns out, that's totally normal. Here's more on why.

How Your Brain and Stomach Are Linked

"The stress-digestion connection is very strong, and I see patients every week who have digestive symptoms related to stress and anxiety," says Nicole Beurkens, Ph.D., a licensed psychologist and nutrition specialist. The most common symptoms she sees? Constipation, diarrhea, abdominal cramps, bloating, and heartburn/acid reflux. So basically everything that can be wrong with your stomach. (BTW, these surprising things are secretly destroying your digestion.)

As you might be able to guess, part of the reason for the strong connection between your mind and your stomach has to do with the gut-brain-axis and your microbiome, or the collection of bacteria living in your GI tract. "The crosstalk between the gut and the brain goes both ways, and when the brain is under increased stress, the gut responds with distress," says Beurkens. When you're stressed, this communication can have both short- and long-term effects. "Over time, stress can cause levels of gut bacteria to become unbalanced, which leads to changes in neurotransmitter function, and perpetuates increased stress and anxiety in the brain."

And while the gut-brain-axis is definitely part of the equation, it's not just about the bacteria in your gut, says Andrea Shin, M.D., a gastroenterologist at Indiana University Health. Stress can also cause inflammation and even change the way your stomach churns food and digests various nutrients, she explains.

Because stress can cause your stomach to tense up, many people also experience symptoms commonly seen in IBS. "When we are stressed out or anxious our sympathetic nervous system gets activated, which causes our gut to be more tense and irritable," says Beurkens. "This can cause the muscles in the gut to spasm, which leads to cramping, diarrhea, and/or constipation depending on where the muscle contractions occur and for how long."

"Increased stress levels also can alter the levels of acid in our stomach, which can cause or worsen heartburn (acid reflux) and impair our ability to digest food properly," adds Beurkens.

In other words, there's not just one way that stress affects your digestive system. And for some people, there may be a combination of factors causing the upset.

How to Tell If Your Stomach Issues Are Caused By Stress

The simplest way to figure out whether your stomach issues are related to stress is to simply keep track of them. "A diary can sometimes help identify common triggers," says Dr. Shin. (Here's more info on how to make food journaling work for you.)

"I often have patients keep a journal to track the presence and intensity of GI symptoms throughout the day and week," says Beurkens. This approach involves writing down what you're eating, how you're feeling emotionally, and how you're feeling physically several times per day. "This helps identify specific patterns of activities or other triggers that may be impacting GI symptoms."

For example, if you're experiencing symptoms right before work on days when you have morning meetings, but you're typically fine other times, that could be an indicator that stress is the issue. Looking for these types of patterns after a week or two of tracking is key. "The biggest telltale sign that GI symptoms are stress-related is that they come and go depending on the amount and intensity of stressors happening in the person's life," says Beurkens. Of course, checking in with your doctor about it isn't a bad idea either.

What to Do If You Have a Stress Stomachache

"If your pain is occasional and not interfering with day-to-day activities, start with lifestyle changes to see if that helps alleviate it," recommends Charles Elson III, M.D., a professor of medicine in the division of gastroenterology and hepatology at the University of Alabama at Birmingham. But patience is essential: "Lifestyle modifications take time and often require a lot of trial and error in terms of figuring out what works," he says. There's no single solution that works for everyone, so be open to trying different things to see what works.

If your stomach problems are caused by what's going on with your mental health, taking care of yourself emotionally is one of the surest ways to feel better faster. "Focusing on self-care and incorporating techniques such as physical exercise, meditation, and healthy eating habits may all be useful in helping to manage your symptoms," says Dr. Shin. (Related: Sneaky Signs and Symptoms of a Food Sensitivity)

"It is also important to get enough good quality sleep each night, as this supports stress reduction and gut health," says Beurkens. Dietary changes can also make a difference. "Reducing caffeine intake improves many common digestive issues, as well as eating more fruits and vegetables and whole grains. Cutting back on fatty foods, dairy products, and processed foods and beverages such as sodas, candy, and fast food can also support gut function and reduce stress-related symptoms."

If these strategies don't work, then it's definitely time to check in with your doctor or health care practitioner, says Dr. Elson. "If your pain is interfering with your life and impacting your ability to do things, then it is certainly worth having it checked."