There’s a bidirectional relationship between gastrointestinal disorders and anxiety. This relationship is thought to be controlled by a gut-brain connection.
Hi, I'm Dr. Tracey Marks,
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.
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
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,
then take a look at this video.
Thanks for watching.
See you next time.

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