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Research on ‘second brain’ shows stress can cause gut health flare ups

The brain and the digestive system are intertwined and everyone at one point in their lifetime has experienced this gut-brain connection. Stress, depression and anxiety can impact the stomach and bowels as they’re controlled by the enteric nervous system, often referred to as “the second brain,” where a network of nerves, neurons and neurotransmitters extends along the entire digestive tract – from the esophagus, through the stomach and intestines.

“Everything in our bodies is controlled by our brain,” says Dr. Brian Bressler, a gastroenterologist with the University of British Columbia and St. Paul’s Hospital.

The gut-brain axis works in both directions. “Pain, bloating and other digestive systems can be very concerning,” says Dr. Bressler. “They impact people’s quality of life.”

Dr. BresslerSupplied

For people with an underlying gastrointestinal condition, the brain has an additional influence. “Stress and other mental-health concerns might impact the immune system,” says Dr. Bressler.

Dr. Bressler believes that the involvement of both a psychologist and psychiatrist may improve the health of patients with these conditions, as well as lead to better understanding how the brain-gut connection works in people who experience persistent gastrointestinal symptoms.

People with a chronic physical condition – not just gastrointestinal ones – are more likely to have major depression. According to the Centre for Addiction and Mental Health, when stress becomes overwhelming and prolonged, it can increase people’s risk for medical conditions.

Krista Brown, who has a Ph.D. in Clinical Psychology, says preventative care can be difficult for a person with a mental-health condition, which puts them at risk for developing illness. And trying to manage an illness can be overwhelming for a person who gets sick.

Dr. Brown says people with chronic gastrointestinal symptoms experience mental health-related challenges in many ways. Managing their stress will help, she says, but won’t “entirely eliminate” a chronic illness if they have one. The guilt and helplessness, she adds, can become a “vicious cycle.”

A practical approach for people with chronic health problems or mental-health challenges is cognitive behavioural therapy (CBT), which helps people change how they perceive situations.

While those who are less resilient are more likely to need mental -health support, says Dr. Bressler, they often have limited social supports.

A study published by Cambridge University Press states social support is considered a social determinant of health.

Dr. BrownSupplied

While people with chronic gastrointestinal conditions are more likely to experience anxiety and depression in “normal” times, during the COVID-19 pandemic, these mental-health concerns worsened.

Fear of getting sick from COVID-19 and having poor outcomes, as well as stress around accessing medical care have impacted how often these patients take advantage of even safe opportunities.

“Some patients have become very isolated and are afraid to go out,” says Dr. Brown.

The relaxation of public health restrictions has complicated things. “Reintegration into society has been a much bigger deal for some of our patients. It’s a huge source of stress,” says Dr. Bressler, as they worry about returning to work, having flare ups in public and getting sick.

Dr. Bressler believes an interdisciplinary approach, such as the IBD Centre of BC, which includes a team of doctors, registered dietitians, nurses, psychiatrists, and psychologists, offering patients support for all the physical and mental aspects of their diseases, should be the norm in Canada.

Looking ahead, Dr. Bressler hopes to collect data on the cost-effectiveness of funding therapy and inspire other centres to offer interdisciplinary care. “We know that if people are not getting the right person to manage their problems, it’s not an efficient use of our health-care system.”

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