The Connection Between Anxiety and Stomach Problems

 https://www.youtube.com/@DrTraceyMarks

Dr. Tracey Marks,

There’s a bidirectional relationship between gastrointestinal disorders and anxiety. This relationship is thought to be controlled by a gut-brain connection. Research studies have concluded that there is signaling between the gut and the brain that affects the way we think and behave. 

a psychiatrist and I make mental health education videos.

Today I'm talking about the connection

between your stomach problems and your anxiety.

I've seen a number of patients with anxiety

who also have gastrointestinal problems.

For some of them,

anytime they have a flare up of their intestinal issue

or stomach issue, it ramps up their anxiety.

Let's look at Paul.

Paul has gastroesophageal reflux disease, also called GERD.

This is where you get acid from your stomach splashing

back up into your esophagus or food tube, as we think of it.

Your stomach lining can handle the acid and bile,

but your esophagus is too delicate for that.

So when that happens,

you get this burning sensation and pain.

And because the junction of your stomach and your esophagus

is around the middle of your chest,

the burning pain can be mistaken for chest pain.

And some people will even think

that they're having a heart attack.

So back to Paul.

Paul is afraid to take any medication and he wants to handle

his GERD by changing his diet to eliminate acidic foods.

This helps a little,

but still get chest pain when he lies down to go to sleep.

And when this happens, he has an attack of anxiety.

So just about every night,

he has panic attacks and has trouble falling asleep.

Because this usually happens every night,

he starts getting anxious late in the afternoon, thinking

about having to go to bed.

He got a recliner chair to sleep in to help with the reflux

and it did a little.

But this whole chest pain, anxiety thing starts

to make him think he's got something bigger going on.

Now he worries that he really has stomach cancer.

Why?

Because he can barely eat.

He's lost about 15 pounds and has trouble keeping down food.

His doctor prescribes a medication for his reflux,

but says that Paul really needs to see a psychiatrist

for his anxiety.

Paul comes to me and says, "I'm not crazy.

"I just have a bunch of medical problems that have messed

"with my mind.

"And I wanna feel better about my health."

Now you may think this sounds a little like health anxiety,

but it's not.

With health anxiety, you worry about having any disease,

whether or not you have real symptoms of it.

And even if you do have an illness,

once that illness is treated,

or you get a workup that shows

that you don't have an illness,

you start to focus on another illness

that you think you have.

In this scenario, Paul has gastroesophageal reflux disease,

and this is something that can be worsened by anxiety,

but GERD can also cause or worsen anxiety.

It turns out there's a bi-directional relationship

between gastrointestinal disorders and anxiety.

This relationship is thought to be controlled

by a gut-brain connection.

Research studies have concluded that there is signaling

between the gut and the brain

that affects the way we think and behave.

So what does this mean?

It means that having a disorder like GERD

or irritable bowel syndrome, or perhaps even colitis

can cause anxiety as well as depression.

Why does this matter?

It matters how you handle the anxiety.

The usual medication treatment for anxiety

is serotonin enhancing antidepressants

like Prozac or Zoloft.

But one of the main side effects of these medications

is gastrointestinal distress

like nausea, diarrhea, or constipation.

So they can make your gastrointestinal illness worse.

It may not.

I have had patients with GERD take acid reducing medication

and still do fine with one of these antidepressants.

But not all do.

So, knowing that the anxiety medication

can worsen your symptoms,

An alternative approach may be to focus

on getting the optimal treatment

for your gastrointestinal symptoms first,

and then using cognitive behavioral strategies

to address your anxiety.

Another topic related to this gut-brain connection

is what the microbiome.

The microbiome is the trillions

of microorganisms called microbes that inhabit your body.

The microbes include bacteria, fungi,

parasites and viruses.

And most of them live in your small and large intestines.

Think of them as like having a population

of organisms living in your body

doing a lot of work behind the scenes

to keep your body functioning.

Some important work that they do is helping

your immune system run properly.

This microbiome is so important that some consider

it to be like a second brain located in your gut.

Researchers have studied the microbiomes of different people

and see that people with anxiety and depression

have a microbiome that looks different

from those without anxiety and depression.

Even the amount of body fat that you carry on your body

is affected by the microbes you have in your gut.

You know how some people seem to be naturally thin

and others large, even when they eat the same things?

Where I come from, they call that being big boned.

This isn't all metabolism.

Your gut health plays a role in this.

So here's how this relates to anxiety.

If gastrointestinal disorders can cause anxiety

and having bad microbes can cause or worsen anxiety,

then maybe the way you can address your anxiety

when you have a gastrointestinal illness

is to get treatment for your GI problem first

and then turn a hard focus to your gut health.

There are some preliminary studies suggesting

that probiotics that contain certain bacteria strains

like lactobacillus and bifidobacterium

could help treat mental disorders.

But the research into this intervention

is still in the early stages and we're not able to say

yet, take this much of this probiotic

to treat this disorder.

But healthy food produces good microbes.

A good place to start with this is eliminating sugar

and processed food and eating a clean diet.

And this will be food that reduces inflammation.

I have a handy guide for you that you can download

from my website at markpsychiatry.com.

If you're a part of my email community,

you got this handout maybe about a month ago.

If you're not, you can still get it from my website.

The link is in the description.

So the take home here

is that if you have gastrointestinal problems like GERD

or irritable bowel syndrome,

these illnesses can cause anxiety.

So make sure you prioritize

having the gastrointestinal problem treated.

Don't ignore it thinking that it's probably just stress.

Because ignoring it could then trigger a bigger problem

of anxiety for you.

Also, you wanna take a serious look at your diet.

I know that that's not an innovative intervention,

but it is real, it matters

and it could make a big difference in how you feel

without the need for taking another medication

to get rid of your anxiety.

If you haven't seen it already, take a look at this video

I did on dealing with health anxiety.

That is a different problem,

as I mentioned from what Paul had.

But nonetheless, if you do tend to focus on having

or have a lot of anxiety about multiple health issues,