Stress and IBD: Why stress can trigger flares and how we can reduce it
Managing and reducing stress is a very important part of managing IBD. Increased stress can hugely reduce quality of life, exacerbate symptoms of IBD and lead to relapse.
How does stress affect us?
Stress affects our gut and bodies in a variety of ways including:
Impairing intestinal barrier function – affecting the links between our gut cells making them more permeable allowing things to get through that shouldn’t, like bacteria and food components, which can cause an immune response (inflammation).
Disturbance of the gut microbiota – altering the make up of the bacteria that live inside us and help to keep us healthy (this is also a causal factor in the onset of IBD).
Intestinal dysmotility - when our gut does not work properly at moving its contents (food, drink, tablets etc.) along. Stress often slows the movement of our small intestine and increases the movement of our large intestine, hence the experience of diarrhoea when stressed.
Immune and neuroendocrine dysfunction – impacting the way our immune system and hormones work which help send messages around our body (this is another causal factor in the onset of IBD).
What is stress?
Stress is often misunderstood to be just a psychological problem related to feeling anxious, depressed or low. But stress comes from many other sources and can have a huge physical impact on our body and our health.
Psychological stress often comes from work, relationships, financial worries, health worries, but there are also physiological stressors. These come from illness, injury, smoking, alcohol, pollution, intense exercise, nutritional deficiencies and, imbalanced blood sugar levels. So, as you can see stress can affect IBD but IBD can be a stress in itself – the effects are what is known as bidirectional (both directions).
Interestingly our bodies can’t distinguish between the two and the reaction is the same – our bodies release adrenaline our fight or flight response and also a hormone called cortisol, our stress hormones. Our stress response is very normal and important protective mechanism to save us from oncoming danger as you can see from this example:
I go to cross the road without looking and step out in front of an oncoming bus.
A complex hormonal cascade happens in my body and my adrenals release adrenaline and cortisol.
These stress hormones prepare my body to ‘fight or flight’ by releasing stored glucose, giving me an immediate energy source to my large muscles. They stop my glucose storage hormone, insulin, from storing glucose so its available for me to use. They also cause my arteries to narrow and increase my heart rate, both of which force my blood to pump harder and faster around my body.
I dash to the other side if the road narrowly avoiding the bus….phew!
My hormone levels return to normal and I continue with my day.
However, nowadays we are often under constant stress, both psychological and physical, never switching off from technology, always rushing around, and things like poor food choices. This means we are constantly in this ‘fight or flight’ mode, which means our stress and cortisol levels remain elevated. This means our blood sugar levels are also raised but we are not using this energy up to fight or flight. Instead we are sitting at our desks and don’t use the circulating glucose. Our bodies are very clever and want our blood sugar to stay within a certain range so it needs to store away this excess glucose and it does this by storing it as fat, usually around our abdominal area as ‘visceral fat’. The helps as a form of protection for our vital organs as our body fears we are under attack.
Not only does stress impact our blood sugar levels and weight, it can also impact our immune and digestive systems. Prolonged stress can have a huge impact on our health, reducing our ability to fight infection and worsening gut related symptoms of IBD and IBS like tummy pain, bloating, gas, diarrhoea or constipation.
So, what can we do?
There are many things we can do every day that can help reduce stress. Although, if you think the stress you are under is too much to cope with its really important you seek professional help. Cognitive behavioural therapy (CBT), gut directed hypnotherapy and mindfulness meditation have been shown to help improve gut symptoms, as well as helping to improve coping, resilience, and self-regulation in IBD.
It is obviously not feasible for us to remove all the stress from our lives. But we do have the ability to managing and counteracting the stress we are under, making sure we are looking after ourselves proportionately.
We need to look at stress levels and our health like our bank account – we don’t want to be spending more than we are putting in, and if we are spending more we need to make sure we are putting more in!
Here are my 7 top ways we can reduce stress:
Balance our blood sugar and energy levels - adrenaline is released when our blood sugars drop too low which trigger the release of stored glucose to get the levels back up again. When we are in this dip we often also feel hangry, depressed and anxious. Making sure we have protein and healthy fats with each meal or snack can help reduce this physical and psychological stress. For example including, meat, poultry, fish, eggs, beans, pulses, lentils, quinoa, nuts or seeds. Also, opting for carbohydrates with more fibre that are more slowly digested and absorbed can help to, for example brown rice, oats, fruit and vegetables, rather than lower fibre and more quickly broken down and absorbed ones like white bread, and sugary snacks (if you can not tolerate higher fibre foods at the moment, that’s OK, just focus on getting protein and healthy fats in with your meals).
Providing our bodies with the nutrients it needs to function and recover - During times of stress we often use up a lot of nutrients particularly magnesium, vitamin C, Zinc and Omega 3 fats. These nutrients are vital for our bodies and immune systems to function properly so we must make sure we are including foods with these nutrients in our diets each day. We find magnesium in wholegrains, legumes, pumpkin seeds, green leafy vegetables, dark chocolate, tofu and nuts like brazils, cashews and almonds. Fruit and vegetables like red peppers, kiwi, kale, cauliflower berries, lemons and oranges all contain vitamin C. For zinc we should be looking to include oysters, liver, beef, lamb, but also pumpkin seeds and beans. And finally, for omega 3 we need to include foods like oily fish (salmon, mackerel, anchovies, sardines and herring), and nuts and seeds like chia, flax and walnuts.
Daily Mindfulness Meditation practice – Just 10 minutes a day using a guided meditation on an app like CALM or Headspace can have a real impact in our stress levels. Meditation may also increase our ability to cope with pain and even reduce our sensitivity to pain, as well as improving our sleep, concentration span and brain function. So, here’s a challenge – download one of the apps (both have a certain amount of free content) and for the next 7 days practice meditation daily. As with any new habit, it can be challenging to start with but keep doing it each day and soon it’ll be part of your routine.
Yoga and movement - Studies have shown the effectiveness of yoga in helping to control IBS and digestive symptoms. Movement and exercise is a really important part of health, and managing stress and anxiety. Even if you can only manage a short yoga practice or a walk around the block, every little helps. Search Joe Wicks (HIIT) or Sophie Dear (yoga) on YouTube for some great real time at home workouts.
Get outside - I know we are only allowed out once a day at the moment but walking in nature in a green space for just 20 minutes has been shown to help lower cortisol levels. I find getting outside in nature so helpful when I am stressed, it helps me to put things in perspective. At the moment I am trying to do a walk once a day as I know its one of the things that really helps me to relax and reduce my stress levels.
Prioritise ‘me time’ - This doesn’t have to be a long time, sometimes 10 minutes is enough but just taking time to stop and take a bath, read a book, do some colouring or painting, whatever helps you to relax and switch off can be really helpful.
Breathe – When we are stressed or anxious we often breath very short shallow breathes. Breathe can be a really powerful tool when we feel ourselves starting to get stressed or anxious to help relax our bodies and calm us down. It sounds strange but I promise it works. Deep breathing exercises are something I do before every talk I give to help me remain calm and focused. Close your eyes when you feel stress or anxiety coming on and breath in for 4 seconds and out for six seconds. Make these really big deep breaths into you belly – you can put your hand on your belly if that helps so you can feel the breathe coming in. Do this, counting your in breaths and out breaths for 10-20 breaths. This is something I learned through yoga and @sophiedearyoga and it has been transformational for me.
I have written a free e-book to help you find a way forward for your everyday life with Inflammatory Bowel Disease. Whether you are right at the beginning of your journey with IBD or have been living with your condition for years and feel like you have tried almost everything, there are things you can do everyday, beyond the medication you are taking, to help you take back control.