Stress & IBD - how can it trigger flare ups and how can we reduce its impact?
What is stress?
Stress is our body’s reaction to feeling threatened or under pressure (1).
Stress can be psychological like family, relationships, work, money, and major life-changing or life-threatening events. It can also be physical like illness, injury, smoking, alcohol, pollution, too much intense exercise, nutritional deficiencies and imbalanced blood sugar levels. Our body reacts in the same way to all of these by engaging our ‘fight or flight’ response.
Our stress response is very normal and is actually a very important protective mechanism to save us from oncoming danger. It can also motivate us and help us to preform. However, very acute and chronic stress can have a negative impact on our health and IBD.
Can stress worsen IBD symptoms? Can stress cause an IBD flare?
The short answer is, yes and yes!
Stress can cause wide-ranging effects on those of us with IBD, especially on our symptoms like abdominal pain, and can trigger flare ups (2, 3).
I have found that stress can have quite a big impact on my symptoms and most of my clients with colitis or crohn’s report that stress impacts them in someway, with many citing stressful events as major triggers for flare ups.
How can stress impact IBD?
The impact of stress on inflammatory bowel disease is complex and happens through may different pathways. Lots of systems are involved including our gastrointestinal, neuronal (nerves), endocrine (hormones), and immune systems.
Stress activates many different systems in our bodies include our brain-gut axis, our hypothalamic-pituitary-adrenal axis (HPA axis), autonomic nervous system (ANS) and enteric nervous system (ENS).
The comprehensive activation of these systems contributes to symptoms and can trigger flare ups by:
Disturbing our gut bugs (microbiota) – altering the balance of the bacteria that live inside us and help to keep us healthy (this is also thought to be a causal factor in the onset of IBD).
Intestinal dysmotility and changes in gut secretions - impacting our gut’s ability to work properly and move its contents (food, drink, tablets etc.) along and the fluids and hormones it secretes to help us digest our food. Stress can slow the movement of our small intestine and increase the movement of our large intestine, hence the experience of diarrhoea when stressed.
Impairing intestinal barrier function – affecting the links between our gut cells making it more permeable, allowing things to get through that shouldn’t, like bacteria and food components, which can cause an immune response (inflammation).
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), including increasing inflammation (4).
How can we reduce stress with our IBD?
It is impossible to remove stress from our lives completely, however, taking a step back and looking at what we can change is really important and putting in place some tactics to help us manage our stress levels more effectively on a daily basis.
Here are my 7 ways we can reduce stress both physically and psychologically:
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.
References
NHS (2021) Feeling Stressed? Available from: https://www.nhs.uk/oneyou/every-mind-matters/stress/#:~:text=Stress%20is%20the%20body's%20reaction,home%2C%20work%20and%20family%20life. (Date accessed: 19th April 2021)
Bernstein CN, Singh S, Graff LA, Walker JR, Miller N, Cheang M. A prospective population-based study of triggers of symptomatic flares in IBD. Am J Gastroenterol. (2010) 105:1994–2002. 10.1038/ajg.2010.140
Jaghult S, Saboonchi F, Moller J, Johansson UB, Wredling R, Kapraali M. Stress as a trigger for relapses in IBD: a case-crossover study. Gastroenterology Res. (2013) 6:10–16. 10.4021/gr528e
Sun, Y., Li, L., Xie, R., Wang, B., Jiang, K., & Cao, H. (2019). Stress Triggers Flare of Inflammatory Bowel Disease in Children and Adults. Frontiers in pediatrics, 7, 432. https://doi.org/10.3389/fped.2019.00432