IBS & Emotions: The Gut-Brain Microbiome Axis

How Emotions Can Trigger IBS—Understanding the Gut, Brain, Microbiome Axis

The Tummy Clinic | January 20th, 2023

Did you know there is a ‘second brain’ in our gut? Hidden in the walls of our digestive system, it’s the source of our feelings which we describe as ‘going with our gut’ when making a decision, or feeling ‘butterflies in our stomach’ when nervous, among others. Called the enteric nervous system (ENS), its study is drawing up exciting new links between digestion, mood, health and the way we think.

What is the ENS?

The ENS is made up of two thin layers of more than 100 million nerve cells. These layers line the gastrointestinal tract from the oesophagus to the rectum. The gastrointestinal tract is sensitive to emotion. When we feel anger, anxiety, sadness, elation, and other emotions, they can trigger symptoms in the gut.

Role of the ENS

The main role of the ENS is controlling digestion. It controls the entire process, from swallowing to the release of enzymes that break down food, to the control of blood flow that helps absorb nutrients, and finally elimination. While the ENS doesn’t seem capable of thought (like our big brain), it communicates back and forth with the big brain.

The brain and the gastrointestinal (GI) system are closely connected. The brain has a direct effect on the stomach and intestines – and vice versa. Thinking of food, for instance, can release the stomach’s juices even before food gets there. In the same way, a troubled intestine also sends signals to the brain. It is a connection that works both ways. Thus, it is possible that a person’s tummy or intestinal distress can either be the cause or the result of anxiety, stress, or depression. When a person experiences gastrointestinal upset with no obvious physical cause, it is important to consider the role of stress and emotion when trying to heal a distressed gut.

The ENS can trigger emotional changes experienced by people with irritable bowel syndrome (IBS) and functional bowel problems such as constipation, diarrhoea, bloating, pain and stomach upset. Now researchers are finding evidence that irritation in the gastrointestinal system may send signals to the central nervous system (CNS) that trigger mood changes.

The gut/ brain/ microbiome axis

The gut microbiome indicates the microorganisms and their combined genetic material in a particular environment. The gut microbiome, which is home to approximately 100 trillion microorganisms, plays a key role in the development of both health and disease. The gut microbiome is made up of a vast ecology of commensal bacteria, archaea, fungi, and viruses. A healthy adult gut microbial profile exhibits both diversity and stability. The microbiota modulates various vital physiological activities and shapes and maintains the immune system. The brain modulates gut function and, in turn, the gut modulates the function of the central nervous system. These pathways are called the microbiota-gut-brain axis (MGBA). The gut microbiota has considerable potential for new therapeutic opportunities, which can target and impact the microbiota-gut-brain axis for treating many challenging diseases.

The link between gut health and anxiety

There is a close interaction between the gut and the brain. It’s the reason why, when under stress, we feel nauseous or experience intestinal pain. The physiology of the gut is influenced by psychosocial factors. Thus, stress, depression or other psychosocial factors can affect the movement and contractions of the GI tract. Some people with functional GI disorders can experience pain more severely than other people do, as their brain responds with more sensitivity to pain signals from the GI tract. What’s more, the existing pain is made worse due to stress. New research findings could help explain why more people with IBS and functional bowel problems also develop depression and anxiety.

The gut-brain connection

It is important to observe whether your tummy or intestinal problems are related to stress. Whether heartburn, abdominal cramps, loose stools or other common symptoms of stress, do keep a track of your experiences and discuss them with your medical expert. This would help arrive at strategies to help deal with the stressors in your life, as well as ease digestive discomforts.

Benefits of therapy and treatment

With therapy to reduce stress or treatment to treat anxiety or depression, the symptoms of some patients with functional GI conditions can improve. Studies find that psychologically based approaches can have better results in treating digestive symptoms as compared to conventional medical treatment alone. Gastroenterologists (doctors specializing in digestive conditions) serve as counsellors, who look for ways to soothe the second brain. They may prescribe antidepressants for IBS, as these medications may calm symptoms in some cases as they act on nerve cells in the gut. As the two brains ‘talk’ to each other, therapies that help one may also help the other.

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Frequently Asked Questions

Managing IBS with diarrhea can be challenging, but making the right food choices can help. Here’s what works for many people with IBS:

  • Low FODMAP diet: This dietary approach helps reduce symptoms like diarrhea, bloating, and stomach pain. It involves removing certain foods and gradually reintroducing them to see which ones trigger your symptoms.
  • Easy-to-digest foods: Stick with foods like plain rice, cooked carrots, zucchini, and lean proteins (e.g., chicken, fish) to ease digestion.
  • Avoiding triggers: Steer clear of fatty, spicy, or fried foods, as well as dairy and caffeine. These can worsen symptoms for many people with IBS.

If you’re unsure which foods work for you, consulting with a healthcare provider can help you create a personalized meal plan.

Bloating, gas, and stomach pain are common in IBS. These symptoms often result from:

  • Gas buildup: Undigested food or fermentation in the intestines can cause gas and bloating.
  • Gut motility issues: In IBS, food may move too quickly or slowly through the digestive tract, leading to discomfort.
  • Food sensitivities: Certain foods like high FODMAP foods can cause bloating or pain.

Managing these symptoms typically involves diet modifications, stress management, and finding the foods that work best for your body.

IBS constipation can be tough, but there are ways to improve bowel movements:

  • Increase soluble fiber: Foods like oats, bananas, and carrots can help soften stool.
  • Stay hydrated: Drinking plenty of water helps keep things moving.
  • Exercise regularly: Physical activity helps stimulate digestion.

If these strategies don’t work, gentle laxatives or stool softeners might be considered, but always under the guidance of a healthcare professional.

Certain foods can make IBS symptoms worse, including:

  • High FODMAP foods: These include foods like onions, garlic, certain fruits (e.g., apples, watermelon), and dairy.
  • Fatty foods: Rich, greasy foods often cause discomfort for those with IBS.
  • Caffeine and alcohol: These can irritate the digestive system and increase symptoms like diarrhea or bloating.

By tracking your food intake and symptoms, you can start to identify which foods are causing flare-ups and work toward a personalized plan.

Constant constipation in IBS can be caused by:

  • Low fiber intake
  • Dehydration: Not drinking enough water can make stool hard and difficult to pass.
  • Stress: Emotional stress often affects digestion and can contribute to constipation.

If constipation persists despite lifestyle changes, consider speaking with a healthcare provider for further assessment and potential treatment options.

Severe bloating can occur when:

  • Gas is trapped in the intestines due to difficulty digesting certain foods or fermentation.
  • Slow motility: In IBS, the digestive system may move food too slowly, leading to bloating.

To manage bloating, consider reducing high FODMAP foods and incorporating more digestive-friendly meals. Stress management techniques like yoga or mindfulness can also help reduce bloating by calming the nervous system.