It’s one of the most common questions that I get – what do I need to do and know about gut health to optimize my mental health?
As a health and wellness coach, and someone with 15 years’ experience supporting people in making healthy lifestyle changes, I am passionate about empowering my clients to feel their best.
One area that researchers are learning more and more about every day is the intricate connection between gut health and mental health. I’ve written about my own journey here (--> coming soon!), and in this post, I am sharing what you need to know about gut health and mental health in order to optimize your health and wellness.
1. The gut and the brain are connected by the vagus nerve
Big picture, we know there is a strong connection between our gut health and our mental health. One of the reasons for this connection is the vagus nerve, which starts in the lower part of the brainstem, travels throughout the body touching on all our organs, and ending in our gut, connecting to the enteric nervous system (the nervous system in our gut).
The delicate (and essential) balance between our parasympathetic (i.e., rest, digest, calm) and sympathetic (i.e., fight, flight, action) nervous systems enable us to be healthy and function to achieve our goals. When this system is off balance, we can experience struggles with numerous systems in our body – such as - cardiovascular (rapid heartbeat, heart palpitations), gastrointestinal (pain, gas, bloating, constipation, diarrhea), respiratory (rapid breathing, tightness in chest), mental/emotional/cognitive (mental health, stress management, anxiety, depression, insomnia, cognitive performance/ability to concentrate) – and overall feeling poor wellbeing and quality of life.
We need our parasympathetic nervous system to be working so that we can relax, recover, rebuild, digest and be calm when needed. We need our sympathetic nervous system to function so that we can stand up and give a presentation, be cognitively alert to respond to questions, drive to work, and this system also slows digestion so that we don’t have a bowel movement during our presentation!
2. Diagnosis with a gastrointestinal condition increases risk of mental health struggles
Unfortunately, when someone is diagnosed with a gastrointestinal (GI) condition (e.g., celiac disease, inflammatory bowel disease, irritable bowel disorder, diverticular disease, gastroparesis), findings from research over the last decade suggest that this person is at increased risk of depression and anxiety (Adibi et al., 2016; Camilleri et al., 2018; Loosen et al., 2021; Person & Keefer, 2021; Zamani et al., 2019; Zhang et al., 2021).
The severity of gastrointestinal symptoms the person experiences is strongly positively associated with the severity of mental health distress the person experiences. That is, the more severe the pain, gas, bloating, etc. the person is feeling, the more severe the depression and/or anxiety the person tends to experience, and this is consistent across a variety of GI conditions (IBS, Cassar et al., 2018; gastroparesis, Woodhouse et al., 2018; and functional dyspepsia, Koloski et al., 2016).
Researchers have also found psychological distress is the best predictor of quality of life among people with GI conditions, even when controlling for intestinal damage and adherence to the prescribed diet (Yastibas & Akpinar 2021, Sherwin et al., 2017). Cross sectional (1 time point) and longitudinal (over time) studies support this finding that ongoing GI symptoms increase the risk of poorer quality of life (Koloski et al., 2012, 2016).
3. Gut health struggles are more likely to precede mental health struggles
For those of you wondering, ok so which comes first, gut health or mental health issues? Koloski and colleagues examined this exact question over the last decade. In 2012, Koloski and colleagues reported that people with functional GI issues without clinically significant depression or anxiety were more likely to report elevated depression and/or anxiety at 12 year follow-up; as well as the inverse – that people reporting elevated depression or anxiety at baseline were significantly more likely to report functional GI issues at 12 year follow-up. Specifically, IBS and functional dyspepsia were reciprocally predictive of depression or anxiety. (Koloski et al., 2012).
Several years later, Koloski and colleagues (2016, in study with 2885 participants) specifically reported that baseline GI disorders were significantly more likely to predict depression or anxiety – with the initial occurence of GI issues was present in 2/3 of cases, whereas initial occurrence of mental health struggles was present in 1/3 of cases.
Either way, if you are feeling mental health or gut health issues, reach out to a trusted health care professional for support as soon as possible.
4. Psychological causes of distress in GI conditions
While everyone’s health journey is unique, the research shows that there are several common psychological factors that are associated with worse GI symptoms. For example, Tribbick and colleagues found that among people with IBD, those that reported feel lower personal control (i.e., that they can do something to help themselves feel better) and lower treatment efficacy (i.e., confidence that the prescribed treatment will work/help them feel better), as well as limited understanding of their condition, also reported worse GI symptoms.
Other GI researchers (Eghbali et al., 2016; Gray et al., 2011; Miceli et al., 2019, Naliboff et al., 2020), have reported on the important role that GI specific anxiety plays in ongoing GI symptoms and mental health. GI specific anxiety refers to “the cognitive, affective, and behavioural response stemming from fear of GI sensations, symptoms, and the context in which these visceral sensations and symptoms occur” (Labus et al., 2007; p.89). We are seeing this feeling more and more often in health coaching as often people with GI specific anxiety have seen every specialist possible, run all of the tests, and everything is ‘normal’, yet the person still feels awful. This type of experience is my speciality. If you are feeling this way (that you’ve tried everything and are stuck in a rut but not sure where else to turn), I’d love to work with you!
Related to GI specific anxiety is the tendency to catastrophize as well as psychological inflexibility.
How often do you feel something in your body and immediately jump to the worst case scenario (i.e., catastrophizing)? What happens after that? Do you feel better or worse? Do you notice that your mind (and body) start to spiral and you feel worse and worse? If so, you are not alone. Catastrophizing is very common among people with chronic GI struggles and is also predictive of worse physical and psychological outcomes (Cassar et al., 2018, Naliboff et al., 2020, Piche et al., 2013, Thakur et al., 2018). Again, this is where a health coach can help!
Psychological flexibility is another concept to consider on your wellness journey. Being flexible – that is able to adapt as the environment, circumstances and situations change specifically regarding eating – helps you to cope with the stress of dealing with a chronic GI issue. People with chronic GI struggles often can get into a cycle of having to plan for any/every social setting with food (which is important), but then when they are in the situation, plans can change. How do you feel when this happens? Does it cause stress or can you ‘roll with the punches’?
Working with a knowledgeable health coach can help with all of these feelings (check out what my clients have been saying here!). You don’t have to feel alone – I’m here to help support you on your journey back to wellness.
KEY MESSAGE
If you are unwell, and know that something is not right, please seek help and advocate for yourself until you get the help you need.
The message that I really want to get across is that it is very common for people with GI struggles to also struggle with mental health.
There are growing calls in the GI community to support people with celiac disease, IBD, IBS with regular psychological support – not just annual consulting with a dietitian and/or gastroenterologist/GP with GI expertise. Please listen to your ‘gut’ (literally!), if you feel like you need more support in coping with GI symptoms, stress, anxiety, overwhelm, big feelings – reach out for support! You do not need to suffer alone or figure it out by yourself. I offer free consults as a health coach specialized in gut health & mental health (BOOK YOUR FREE CONSULT HERE), or reach out to me for a list of practitioners I recommend to help with your healing journey.
References
Adibi, P., Keshteli, A. H., Daghaghzadeh, H., Roohafza, H., Pournaghshband, N., & Afshar, H. (2016). Association of anxiety, depression, and psychological distress in people with and without functional dyspepsia. Advanced Biomedical Research, 5.
Camilleri, M., Chedid, V., Ford, A. C., Haruma, K., Horowitz, M., Jones, K. L., Low, P. A., Park, S.-Y., Parkman, H. P., & Stanghellini, V. (2018). Gastroparesis. Nature Reviews Disease Primers, 4(1), 41. https://doi.org/10.1038/s41572-018-0038-z
Cassar, G., Knowles, S., Youssef, G. J., Moulding, R., Uiterwijk, D., Waters, L., & Austin, D. W. (2018). Examining the mediational role of psychological flexibility, pain catastrophizing, and visceral sensitivity in the relationship between psychological distress, irritable bowel symptom frequency, and quality of life. Psychology, Health & Medicine, 23(10), 1168-1181.
Koloski, N., Jones, M., & Talley, N. (2016). Evidence that independent gut‐to‐brain and brain‐to‐gut pathways operate in the irritable bowel syndrome and functional dyspepsia: a 1‐year population‐based prospective study. Alimentary Pharmacology and Therapeutics, 44(6), 592-600.
Koloski, N. A., Jones, M., Kalantar, J., Weltman, M., Zaguirre, J., & Talley, N. J. (2012). The brain-gut pathway in functional gastrointestinal disorders is bidirectional: A 12-year prospective population-based study. Gut, 61(9), 1284-1290. https://doi.org/10.1136/gutjnl-2011-300474
Loosen, S. H., Paffenholz, P., Luedde, T., Kostev, K., & Roderburg, C. (2021). Diverticular disease is associated with an increased incidence rate of depression and anxiety disorders. International Journal of Colorectal Disease, 36(11), 2437-2443.
Person, H., & Keefer, L. (2021). Psychological comorbidity in gastrointestinal diseases: Update on the brain-gut-microbiome axis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 107, 110209.
Sherwin, L. B., Leary, E., & Henderson, W. A. (2017). The association of catastrophizing with quality-of-life outcomes in patients with irritable bowel syndrome. Quality of Life Research, 26(8), 2161-2170.
Woodhouse, S., Hebbard, G., & Knowles, S. R. (2018). Exploring symptom severity, illness perceptions, coping styles, and well-being in gastroparesis patients using the common sense model. Digestive Diseases and Sciences, 63(4), 958-965.
Yastibas, C., & Akpinar, Z. (2021). Personality traits and health-related quality of life in irritable bowel syndrome (IBS) patients: The mediating role of illness perceptions. Psychological Studies, 66(2), 200-211.
Zamani, M., Alizade-Tabari, S., & Zamani, V. (2019). Systematic review with meta- analysis: The prevalence of anxiety and depression in patients with irritable bowel syndrome. Alimentary Pharmacology and Therapeutics, 50(2), 132-143.
Zhang, M., Hou, Z.-K., Huang, Z.-B., Chen, X.-L., & Liu, F.-B. (2021). Dietary and lifestyle factors related to gastroesophageal reflux disease: A systematic review. Therapeutics and Clinical Risk Management, 17, 305.