Some experts call the gut the second brain. But why is that? The connection between what’s going on in your brain and what’s happening in your digestive system may be stronger than you know — and it may also be a two-way street.
Demi’s Story
Demi Dalisay Ricario, 51, from San Diego, California, started having digestive issues in college while managing studies and dealing with the nerves that come along with a college crush. “I had butterflies whenever I saw him, but it was more intense,” said Ricario. “My crush would send me to the bathroom!”
But things took a turn when Ricario turned 40. “I describe it as my midlife crisis because it’s when I was diagnosed with ulcerative colitis.” Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that causes inflammation and ulcers in the colon. Ricario knew something was wrong when she noticed blood in her stool and began making more trips to the bathroom. In addition to the physical symptoms, Ricario noticed how a stressful career at the time led to increased symptoms.
“I worked in hospitality for a luxury property, and my role focused on VIPs with many personalities,” says Ricario. “In hospitality, you have to put on a show, look a certain way, smile a lot, and be perfect.” Ricario says absorbing a lot of stress and negative energy increased her bathroom trips and led her to have a serious meeting with HR. “They were understanding and moved my office closer to the bathroom,” she says. “But you can’t just leave a hotel guest and easily run to the bathroom!”
The job took a toll on her body and mind until Ricario pivoted from a COVID-era layoff, took classes in social media marketing, and landed a remote job in a new field.
Stress and Inflammation Connection
Like a wrecking ball, stress can roll through your body without regard for its damage. Some stress is normal, but long-term or severe stress can affect all systems of your body. Stress can lead to tense muscles, headaches, increased blood pressure, and yes — it can affect the gut. This explains why you may feel a weird feeling in your tummy when nervous (aka, butterflies) or feel bowel urgency before a big test or meeting.
Stress can cause bloating, pain, and affect how well nutrients are absorbed. For the digestive system, the relationship is even stronger.
“IBD is a growing and diverse condition, which for many, can lead to increased stress and anxiety,” says Ariel Jordan, MD, a gastroenterologist and second-year fellow at the University of Michigan. “My own stress during medical school impacted my UC, so I was motivated to study the connection and help others.”
The Gut-Brain Connection
These days, experts are understanding more and more that your gut and brain are strongly connected.
Think of them as siblings — who sometimes get along and sometimes don’t. When all is well, you feel great! When there’s some fighting or poor communication, it can lead to inflammation and pain — both key IBD symptoms.
While siblings may connect via phone, text, or social media, your brain and gut ‘talk’ through nerves (especially the vagus nerve), hormones (like serotonin), and the gut biome. All three communication channels have been studied more in recent years.
One study looked at children with IBD who received electrical stimulation of the vagus nerve (the main communication nerve between the brain and other organs). Of the 22 patients, half with Crohn’s or UC were in remission after the trial. Still, more research is needed to understand how helping the brain and nervous system may help your digestive system and vice versa.
What you should know:
- Your gut has over 100 million neurons that talk to your brain and other body systems.
- More than 90% of your ‘happy hormones’ like serotonin live in your belly, chemicals that help with sleep, memory, and sex drive.
- Your gut has both good and bad bacteria, but an imbalance can lead to inflammation. Inflammation worsens conditions like UC.
- Mindfulness and medication techniques may lessen IBD symptoms.
What does it all mean? The treatment for UC may change and improve over time. Also, doctors may better understand the connection between your brain and gut.
A home for the microbiome
So, what’s all the talk about healthy gut and your microbiome?
Your digestive system has a lot of bacteria — mostly good unless something is off. “I like to say our digestive system has checks and balances,” says Jordan. “The problems arise when we destroy the good bacteria — either through overuse of antibiotics (which kill both bad and good bacteria) or through lifestyle habits.”
The Emotional Side of UC
It’s normal to feel emotions such as sadness, anxiety, anger, or loneliness when you have a chronic condition like ulcerative colitis (UC). In fact, studies show that more than half of older adults with digestive conditions like UC experience feelings of isolation and loneliness.
If you live with UC, you may very well know the anxiety of finding a nearby bathroom — or the isolation of having to cancel plans due to extreme symptoms like cramping, bleeding, or fatigue.
Feeling drained is not in your head. Research shows that 80% of patients with active IBD (like UC) and 50% of those with controlled IBD have fatigue.
Trust your gut may have never been a truer statement. Your brain and digestive system ‘talk’ regularly, so when one is out of balance, the other is affected as well. “My patients will often say they feel more bowel symptoms when they’re stressed,” says Jordan. “I try to help them understand that there are so many nerves in the gut communicating with the brain.”
What Can Be Done?
If you have UC, you may feel hopeless at times, but some simple things may help you manage the ups and downs.
“Living with an IBD condition can impact your quality of life in big ways,” says Jessica Naftaly, PhD, a clinical psychologist who specializes in helping people with IBD and battles the condition herself. “It can be tough to navigate school, work, social, and romantic relationships.” Sometimes being able to talk about those things and then using coping skills can help UC symptoms. Mental health doesn’t cause IBD, but managing one can help the other.
Here are some tips for your coping skills toolbox:
When stressed about where the closest bathroom is. Map your route in advance, including bathrooms, when on a long or short trip. Or, use the Crohn’s and Colitis Foundation bathroom finder app — “We Can’t Wait” — available on iPhone and Android devices. Deep belly breathing may also help with the anxiety of searching for a bathroom.
When battling a severe case of fear of missing out (FOMO). Cancelled plans, missed dates, and skipped events can often feel like part of everyday life with UC. Start with identifying your priorities (family, health, etc.) and then see where everything else fits in. You may not be able to attend everything, but can you join virtually, attend for a brief time, or connect with your friend or family member at a later time?
When loneliness or isolation creeps in. Expanding your support group to other people who have IBD and UC may help. Check out organizations like the Crohn’s and Colitis Foundation, Girls with Guts, Color of GI, or even camps for youth with IBD, such as Camp Oasis.
When you are just downright angry. “Get curious about your emotions and what they are saying to you — including anger,” says Naftaly. “Talking through it all in therapy or with others in your same condition can help a lot.” Experts like Naftaly and others suggest focusing on your basic needs — getting enough sleep, exercise, good food, and social time — can lessen intense emotions like anger.
When you feel like a burden to your family. “First, this is often not true if you ask friends and family,” says Naftaly. “But if you feel this way, try spreading the needs around. Consider leaning on one person for emotional support, maybe another for practical needs like rides to doctor appointments. ”
When you feel overall overwhelmed. Try deep belly breathing, called diaphragmatic breathing, says Naftaly. “Helping the belly move can help with GI [gastrointestinal] symptoms and anxiety.” In some cases, gut-focused relaxation or even hypnosis can help those in remission (according to their labs) who still have symptoms.
These tips may be a start, but find a good therapist to help you deal with your emotions as you live with UC. Some specialize in helping people with chronic conditions like UC. “I want patients to know they’re not alone and there are many GI psychologists out there to help,” says Naftaly. “Also, you don’t need to have a mental health condition or be in crisis to benefit from counseling.”
Happy Belly and Brain
Experts like Jordan suggest being good to your gut is a three-pronged approach that includes the right meds, the right meals, and mental support. “Medications work to calm inflammation, and your diet is important too,” says Jordan. “Lastly, making sure you’re not ignoring the connection between your digestive health and mental health is key.”
Here are a few tips to address these three key areas:
- Make sure you have a doctor who specializes in gut health (typically a gastroenterologist) in addition to your regular doctor.
- Talk to your doctor about medications for your UC that may help your symptoms and lower the number of flares.
- Eat foods that are proven to replace good bacteria in your gut, such as plain yogurt and fermented foods like sauerkraut, kimchi, and kombucha tea.
- Remember: While probiotics, prebiotics, and peptides may help some people manage digestive systems, there is still little data to support a connection. “Overuse of supplements can lead to toxicity in your body,” says Jordan. “You’ll want to work with your doctor to make a plan.”
- Ask your doctor about a gastrointestinal-focused therapist or find one through the ROME GastroPsych Directory.
“Living with UC is not easy, but I choose to remember that my purpose is bigger than my disease,” says Ricario. “I am an only child and staying healthy for my parents. And, I’m going to continue to enjoy life — wear makeup, enjoy fashion, and travel the world.”
Related Links 
