About the Author
Jeanne Faulkner is a freelance writer and registered nurse in Portland, Ore. Her work appears regularly in Pregnancy and Fit Pregnancy, and she has contributed articles to the Oregonian, Better Homes & Gardens, Shape and other publications.
Why do we get gut feelings? Can butterflies in your stomach multiply? Why does your stomach get in knots? Good questions. Stomach pain is one of the complaints patients have the most, and it can indicate anything from appendicitis to food poisoning to ulcers and more. If the big bad stomach problems are ruled out, though, your tummy ache might be stress-related.
Indigestion, irritable bowel disease and heartburn all include "stress" as a contributing factor. We spoke with doctors Derek Taylor, M.D., gastroenterologist at Northwest Gastroenterology, in Portland, Ore., and Laura Washington, ND, naturopath at Portland's the Art of Health, about their perspectives on stress and digestive health.
Q: What is "digestive pain?" Dr. Washington: "The most obvious digestive pains are intestinal gas, bloating and cramping, heartburn, stomach or duodenal ulcers and pain with elimination."
Q: How does stress affect our digestive health? Dr. Washington: "Fight or flight is a natural short-term stress response. This part of the nervous system is called the sympathetic aspect, while the opposite, the parasympathetic aspect, supports rest, digestion and absorption of nutrients. The sympathetic state inhibits digestion and absorption because in that life-threatening moment there are more important things to do than digesting food. This works well when threats are few. Unfortunately many people are in prolonged stressful situations, or circumstances are perceived as stressful so the body goes into sympathetic dominance and digestion is impaired. That leads to chronic digestive upset."
Q: Then, what happens to the food in your system? Dr. Washington: "Shutting down digestive processes leads to putrefied food in the intestines. This contributes to imbalanced digestive flora and causes chronic gastrointestinal pain."
Q: How are our emotions connected to our stomach?Dr. Taylor: "We channel emotions into our gut. Stomach pain is a body manifestation of anxiety and fear. Some people only get that churning feeling during stressful situations like public speaking. Others experience it daily and have nausea, diarrhea and poor appetite. In medical school, plenty of students made sudden trips to the bathroom right before important exams."
Q: What symptoms do you see? Dr. Washington: "It varies depending on predispositions or weak areas. It may be heartburn, because the stomach decreases secretions. [It could be] bloating, flatulence or cramping pain, because of inhibited gallbladder or pancreatic secretions."
Q: Do many patients have stress-related digestive complaints? Dr Taylor: "I see them all the time. Patients may have lived with them for a long time and it's ruling their life. They go from doctor to doctor trying to figure out what's wrong. They've had every test available and no one finds anything abnormal. When that happens, we go back to ground zero. We talk. I'm a big fan of the brain and body being one. If they're in chronic pain, the body's grabbing their attention. Trauma, anxiety and fear stay in our bodies, most commonly in our stomachs, until we resolve it."
Q: What stressors cause these problems? Dr. Taylor: "Let's define 'stress.' It's become a catchall phrase, when really what we're talking about is fear, anxiety, anger or sadness. In our society, it's not acceptable to express those feelings. We don't develop appropriate coping skills. Doctors tell patients, 'It's all in your head.' That's an abusive way to treat people. The pain is real. It's really disrupting their life and health. Our feelings are legit and serve a purpose. As medical doctors, it's good to keep an eye on physiologic illness, but you also have to look at issues like trauma, neglect and anxiety. Many doctors don't want to open that door."
Q: What should patients do to combat stress? Dr. Washington: "Exercise is a great approach. Moving the body uses up chemicals released into the blood stream during the stress response and helps the body reestablish a balanced resting state. I like yoga for managing stress. Breath-work coordinated with gentle movements specifically helps balance the sympathetic and parasympathetic autonomic nervous systems. With a regular yoga practice, one begins to perceive circumstances differently and no longer finds them as stressful. This decreases the amount of time in the stress state, and digestive processes can unfold as they are designed to."
Dr. Taylor: "I recommend journaling to identify feelings, therapy for unresolved issues, and meditation. I also &hellip discuss harmful practices patients use to numb stress, like alcohol, cigarettes, drugs and Internet abuse. It's an important opportunity to look at problems and improve coping skills."
Q: What else can patients do to improve their digestive health? Dr. Washington: "I recommend patients do a digestive cleanse [like fasting], followed by probiotics and prebiotics. Probiotics are healthy living microorganisms taken in supplement form or by consuming yogurt or kefir with live cultures. Prebiotics are foods that nourish, activate, and encourage healthy multiplication of beneficial microbes. Good prebiotic foods include garlic, onions, carrots, and cabbage."
Dr. Taylor: "Nutrition, stress reduction, improved coping skills, exercise, and improved lifestyle habits frequently have dramatic, positive effects. Patients need to really listen to their bodies."