action – as if you are Cro-Magnon man running from a cave bear. This reaction occurs for any perceived stress – literally running from a bear, fi ghting with a loved one, getting into an accident, public speaking, even negative self-talk. After the perceived threat is gone, the body is still processing it during the resistance phase. This helps the mind and body continue to handle emotional crises, fi ght infections or perform strenuous tasks. If the threat dissipates, eventually the body returns back to baseline – feel- ing healthy and having energy. However, if the stressor becomes frequent or prolonged, the body cannot get back to baseline and the exhaustion phase is reached.
Understanding how to manage stress is going to be critical
for anyone suffering from IBS, especially considering that IBS pa- tients often report more stress and anxiety than the general popu- lation. The exhaustion phase is not inevitable, however. Learning in what ways the body regulates its stress response and how each stressor is perceived is an important step towards reducing stress on the body.
Regulating the Stress Response – The H-P-A Axis Selye’s General Adaptation Syndrome is a simplifi ed version
of the body’s stress response. In reality, there are many compli- cated, highly coordinated processes going on in the body. As soon as a stress or threat is perceived, the brain activates the body’s sympathetic nervous system which stimulates the release of epinephrine and norepinephrine from the adrenal glands. This reaction is typically known as the “fi ght or fl ight response” and coincides with the alarm phase. During this response heart rate, blood pressure, breathing rate, alertness and metabolic rate all increase while digestion and urine output decrease.
At the same time, the hypothalamus, pituitary and adrenal
glands all work in concert to continue regulating the body’s stress response. This intimate relationship is called the Hypothalamus- Pituitary-Adrenal (HPA) Axis and is responsible for regulating the body’s long-term stress response. In response to stress, there is a trickle-down effect in the HPA axis – the hypothalamus re- leases corticosterone releasing factor (CRF) which stimulates the pituitary to release adrenocorticotrophic hormone (ACTH) which stimulates the adrenal glands to release cortisol.
The more frequent and prolonged a stressor is, the more
CRF, ACTH and cortisol the body produces and the higher the risk of dysfunction in the HPA axis. Additionally, the body’s chain reaction to CRF production can lead to intestinal permeability, a contributing factor in IBS. This intestinal permeability then creates additional stress on the body through increased infl am- mation, another contributing factor in IBS, stimulating the HPA axis. The end result is a vicious snowball effect of more intestinal permeability, more infl ammation and a prolonged stress response. These types of physical stressors, however, may be mitigated through better regulation of non-physical stressors including how the brain perceives stress.
Perceived Stress – How the Brain and Gut Communicate
There are many physical stressors that may activate the stress response – illness, extreme hot or cold, physical trauma, sleep disturbances, obesity, insulin resistance, low physical activity or over-training, and infl ammatory conditions including arthritis, allergies and intestinal permeability. Although most of these may be under the power and control of the individual, one category of stressors may feel even more overwhelming than the physical: perceived stress.
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Each person handles stress differently. Some people can let things roll like water off a duck’s back. Others may feel paralyzed by each perceived threat. This perception of each threat encoun- tered is what truly dictates the individual’s stress load. Stress from relationships, fi nances, work, self-loathing, lack of control, and general anxiety can sometimes feel harder to manage. Yet, these emotional stressors may be what is causing the most harm in IBS sufferers because of the gut-brain connection.
The digestive system has its own separate nervous system running through it, called the Enteric Nervous System (ENS). This nervous system has hundreds of millions of neurons that create a direct link between the gut and brain. Through this neuronal communication highway, the gut provides feedback to the brain and the brain provides feedback to the gut. This communication regulates gut motility, sensory perceptions such as pain, and the production of secretions in the digestive tract like stomach acid and hormones. Activity in the digestive tract is controlled by this communication as well as the parasympathetic, or “rest and di- gest,” nervous system. This part of your autonomic nervous system helps calm you and promotes all aspects of the digestive process.
The issue arises when the “rest and digest” nervous system
cannot be activated due to stress. This is because the sympathetic nervous system works in opposition of the parasympathetic ner- vous system. If the body is in “fi ght or fl ight” mode, it cannot also be in “rest and digest.” Chronic stress infl uences this gut-brain communication which greatly impacts many aspects of digestive health including gut motility, visceral pain perception and intesti- nal permeability – all contributing factors in IBS. Because the gut- brain communication pathway is highly infl uenced by perceived stressors, it becomes apparent that stress can play a signifi cant role in the development or recurrence of IBS.
The Role of Stress in Irritable Bowel Syndrome
There is a substantial amount of research indicating stress has an enormous impact on whether an individual will suffer from IBS symptoms. Research has shown:
• Emotional stressors of anxiety and depression are common among IBS patients
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