How stress influences your gastrointestinal health

Stressful events aren’t the same for everyone. While almost all people are alarmed by very loud noises or aggressive situations, only some are chronically stressed by more mundane events in everyday life. In all cases, the brain triggers a dual hormonal response involving catecholamines on the one hand and cortisol on the other.

Catecholamines, such as epinephrine (adrenaline) and norepinephrine (noradrenaline), act as first responders to situations that are interpreted as a threat by the brain. We’ve all experienced some of the side effects of this response when we’re startled, narrowly avoid an accident or experience a panic attack: sweating, increased heart rate, breathing and blood pressure, red cheeks, trembling, etc. These unpleasant effects conceal a whole series of important physiological mechanisms that occur simultaneously and serve to fight or flee the danger. The catecholamine response is rapid but short-lived. It becomes harmful if it’s repeated too often.

At the same time as it stimulates the production of catecholamines, the brain instructs the pituitary gland to stimulate the secretion of cortisol by the adrenal glands. Together with catecholamines, cortisol releases glucose into the bloodstream to meet energy needs from glycogen, fat and even protein reserves. It inhibits energy-intensive functions such as growth, digestion and reproduction. The effects of cortisol aren’t as noticeable as those of catecholamines. However, they last longer and become harmful if stressful episodes are chronically repeated.

Read more: When should you worry about abdominal pain?

Of course, the digestive system can’t escape the combined effects of catecholamines and cortisol. Who hasn’t felt discomfort such as a knotted stomach, bloating, nausea, or the urge to have a bowel movement or urinate before or during a particularly stressful event? These phenomena occur when the brain directs all of its attention to the fight or flight response. This response involves a part of the nervous system called the “sympathetic nervous system.”

The price paid for this mobilization of the sympathetic nervous system is the decreased activity of another nerve network, the parasympathetic nervous system. This system, through the vagus nerve, normally relaxes the muscles and increases bowel movements. At the same time that bowel movements are slowed by the reduced activity of the vagus nerve, the nerve that controls the bladder and rectum remains active, resulting in the urge to urinate or defecate when experiencing stress.

Over the long term, chronic stress can lead to many gastrointestinal complications by aggravating existing conditions such as the following [2]:

• Inflammatory bowel diseases (IBD)
• Irritable bowel syndrome (IBS)
• Gastroesophageal reflux disease (GERD)
• Peptic ulcers

Several studies demonstrate that chronic stress can increase the risk of relapse in patients with Crohn’s disease or ulcerative colitis. The mechanisms are complex, but certainly include the ability of stress hormones to decrease the immune response and increase the inflammatory response.[3]

Although we don’t know all the mechanisms at work, irritable bowel syndrome has a major psychological component. There is constant, two-way communication between the brain and intestines, which is sometimes considered our “second brain.” This communication involves mediators of nerve transmission, hormones secreted by the digestive tract which act on the brain, and many molecules produced by the microbiome (the collection of bacteria that colonize the intestine).[4]

To learn more about these conditions, consult our neat little guide to digestive disorders.

Studies on a large number of subjects have shown that the level of stress and anxiety is significantly higher in people suffering from gastroesophageal reflux disease than in others.[5]

To protect the intestines from the effects of stress, we must first protect ourselves from stress. There are dozens of ways to do this, and everyone should try to find the one that works for them. Here are a few examples adapted from the Health Canada website [7]:

• Try to create a work-life balance.
• Take the time to laugh and have fun.
• Learn to delegate. Don’t try to do everything yourself.
• Try yoga, meditation or visualizing happy events.
• Take regular walks or listen to music.
• Get some exercise.
• Learn how to manage your time (establish priority lists).
• Eat a healthy diet (beware of alcohol and overly rich meals).
• Get some rest and the sleep your body needs.
• Talk about your problems with your loved ones or a counsellor.
• Take a vacation once in a while.
• Learn to not always have the last word. Be less competitive.
• Don’t try to be perfect.

For people who suffer from anxiety, medications such as anxiolytics and some antidepressants may be helpful.[8]

We provide services that can help your doctor diagnose stress-related disorders and determine whether a medication may be ineffective or cause adverse effects. Please note that these tests are not used to measure stress levels, and that this is a non-exhaustive list.

• Pharmacogenetic services
• Urine cortisol test
• Morning cortisol test
• Salivary cortisol test
• Catecholamines

Do you have a doctor's prescription on hand for one of these tests? Book an appointment online or contact Biron Health Group’s customer service at 1 833 590-2712.