How stress wreaks havoc on your gut – and what to do about it

One of the major recurring themes of the Paleo f(x) Theory to Practice Symposium I attended this past weekend was the importance of managing your stress.

Beyond poor diet, many other lifestyle factors can greatly increase your level of stress, such as overtraining, not sleeping enough, or not including enough pleasure in your daily life. Many of the conference speakers (including myself) focused on how stress causes cortisol dysregulation and subsequent weight gain, sleep disturbances, and even a reduction in life span.

Stress also plays a major role in the health of one of our most important organ systems: the gut.

The word stress is a broad term, and can refer to any real or perceived threat to the homeostasis of an organism, eliciting adaptive responses to help maintain internal stability and ensure survival. (1) Stress can be acute or chronic, and it tends to be those chronic stressors from our lifestyle or environment that are far more damaging to our health.

The gut is especially vulnerable to the presence of chronic (and even acute) stress, demonstrating stress-induced changes in gastric secretion, gut motility, mucosal permeability and barrier function, visceral sensitivity and mucosal blood flow. (2) There has also been evidence to suggest that gut microbiota may respond directly to stress-related host signals. (3)

I’ve spoken extensively before about the brain-gut axis and its role in health. As I’ve mentioned before, the intestinal mucosa is infiltrated by the myenteric plexus, which is a network of nerve fibers and neuron cell bodies that are influenced by signaling from the brain. In this sense, the gut is an integral part of the nervous system, so the brain can easily effect gut function. We anecdotally recognize our brain-gut connection as a “gut feeling”, which can range from butterflies in the stomach to full-on anxiety-induced nausea. (4)

The biochemical changes that occur in times of stress have significant and immediate impact on gut function.

A family of peptides called corticotrophin releasing factors (CRF) are responsible for coordinating the body’s response to stress, and CRFs have a potent effects on the gut through modulation of inflammation, increase of gut permeability, contribution to visceral hypersensitivity, increased perception to pain, and modulation of the gut motility. (5) This hormone affects the hypothalamic-pituitary axis (HPA) to eventually stimulate the secretion of cortisol from the adrenal glands.

Not only does stress affect the physiological function of the gut, but it has also been shown to actually cause changes in the composition of the microbiota, possibly due to the changes in neurotransmitter and inflammatory cytokine levels. (6) Research in mice has found that exposure to stress led to an overgrowth of certain types of bacteria while simultaneously reducing microbial diversity in the large intestine of the stressed mice. (78) Furthermore, this disruption of the microbiota increased susceptibility to enteric pathogens.

Chronic exposure to stress may lead to the development of a variety of gastrointestinal diseases such as gastroesophageal reflux disease (GERD), peptic ulcer disease, IBD, IBS, and even food allergies. (9) Experimental studies have shown that psychological stress slows normal small intestinal transit time, encourages overgrowth of bacteria, and even compromises the intestinal barrier. (10) Chronic stress may therefore play an important role in the development of small intestinal bacterial overgrowth (SIBO) and leaky gut syndrome.

The Gut-Brain-Skin Axis plays an important role in our overall health.

Another fascinating line of research that dates back to the 1930s is the relationship between skin, gut, and mental health. I recently recorded a podcast in which I discussed the role that gut health plays in the development of acne, and research suggests that chronic stress may also play an integral part in the gut-skin axis. (11) Stress-induced alterations to microbial flora could increase the likelihood of intestinal permeability, which in turn sets the stage for systemic and local skin inflammation. (12) When gut integrity is compromised, an increase in circulating endotoxins derived from gut microbes can manifest as skin eruptions such as rosacea and acne.

On the flip side, having a healthy gut flora can modulate the hypersensitivity and leaky gut permeability that comes from chronic exposure to stress. Consuming probiotic foods and/or supplements might influence both mood and acne, by reducing systemic inflammatory cytokines and oxidative stress, increasing peripheral tryptophan levels, normalizing brain levels of stress hormones, modulating tissue lipid levels, and possibly even regulating glycemic control. (1314151617)

Recently, research has demonstrated significant improvements in depression, anger, anxiety, as well as lower levels of cortisol among otherwise healthy adults taking a daily probiotic supplement as compared to a placebo. (18) This data suggests that not only can chronic stress change the diversity of microflora in the gut, but that the quality and health of friendly gut bacteria may also conversely have an effect on mental health and wellbeing.

As we continue to learn more about the intricacies of the interplay between stress and gut health, what steps can we take in our daily lives to help minimize the health damage that arises from chronic stress?

One interesting method of treatment that researchers used in the 1930s to treat acne and mood disorders was the combination of “an acidophilus milk preparation and cod liver oil”, which we now know provided patients high levels of probiotics, omega-3 fatty acids, and fat soluble vitamins A and D. (19) Healing the gut, reducing inflammation, and providing a diverse array of friendly bacteria can make a big difference in your gut’s susceptibility to the negative effects of stress. Taking cod liver oil and probiotics on a regular basis may make a significant difference in your overall resilience to stress.

That said, it goes without saying that a major component of a healthy lifestyle should include stress reduction techniques. 

As I mentioned before, many of my colleagues at the Paleo f(x) Conference focused on reducing stress as a key component of weight loss, longevity, and mental health. Stress may even cause hypothyroid symptoms such as weight gain, blood sugar swings, fatigue, decreased immunity, and sleep disturbance. I highly recommend that anyone struggling with these types of symptoms evaluate the level of stress in their life, and incorporate different strategies for minimizing stress on a regular basis.

There are many ways to mitigate the impacts of stress, including meditation, yoga, taiji (“Tai Chi”), deep breathing and spending time in nature – to name a few.  However, here are two options that I’ve found to be particularly helpful for healing the gut-brain axis:

  • The Body Scan (Mindfulness-Based Stress Reduction, MBSR): MBSR was developed by clinical psychologist and long-time Buddhist practitioner Jon-Kabat Zinn to cultivate greater awareness of the ways the unconscious thoughts, feelings, and behaviors can undermine emotional, physical, and spiritual health.  It has been studied extensively at the Stress Reduction Clinic at the University of Massachusetts Medical Center for over 30 years, and is clinically proven to relieve chronic pain and illness.  You can download a free audio recording of the Body Scan here, and I recommend doing it once a day if possible. If you prefer more in-depth training, MBSR is offered as an 8-week intensive in hospitals and medical centers around the world. It is also offered as an online course, and can be done via home study with books and audio recordings.
  • Rest Assured is marketed as a program for healing insomnia naturally – and it’s very effective for that purpose. However, the way this is accomplished is by maintaining a greater state of relaxation and ease throughout the day, which will improve not only sleep but other physiological processes like gut function. As I’ve shown in this article, operating in a state of constant hyper-arousal (which many of us do) is a sure-fire path to digestive problems. The Rest Assured program contains simple exercises that coordinate breath and movement. Many of the exercises can be performed in as little as 3-4 minute throughout the day, while some take 20-30 minutes and can be done when you have a little more time – or while you’re laying in bed before sleep. I’ve found these to be incredibly helpful myself, and my patients have as well.

You can read more about my tips for stress reduction, as well as other components of an optimally healthy life, by signing up for my Beyond Paleo email series.

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  1. Joanna says

    Thanks for this great article – as a busy grad student at the end of the semester, I can definitely attest to this relationship! Just one question – I take acidophilus, which seems to help, but I’m wondering if there is a best time to take it (i.e., time of day and time before a meal)? Thanks again, very informative!

  2. says

    Very interesting article Chris. Yes, stress has the effect to either create or make any illness worse! One of the most effective stress relief methods is the use of HeartMath®’s freeze frame and other techniques. I guide people to use a biofeedback type of device that shows them how they can actually change their heart rate variability (which is a marker of stress). Instead of using eating “comfort food” for stress relief (that doesn’t work, and adds pounds), it’s best to go to the source and resolve the stress! It helps people feel calm, improves their health, and can even help them lower their weight – all without dieting!

  3. Ceejay says

    As always, a very interesting and important topic! I have a somewhat related (but somewhat different) question about gut health, specifically about FODMAPs and the GAPS diet, which I know you’ve talked about several times. From what you’ve said before, it sounds like going on the GAPS diet could be an effective way of healing the gut from the underlying issues that cause FODMAPs intolerance. I went on the GAPS diet about 2 months ago because I’ve had lots of gas and gut pain issues for the past couple of years. I wasn’t experiencing any relief in the symptoms, so I tried cutting out FODMAPs and finally did experience a major improvement (though I still have minor pain every now and then, and small amounts of gas). I’m sticking with GAPS for now in the hope that I can heal my gut and eventually tolerate FODMAPs a little more. My question is this: would it have been possible to heal my gut without cutting out the FODMAPs and just staying with GAPS? Or does it delay my healing every time I eat a FODMAP food that my body can’t digest? I’m trying to figure out how aggressive I should be in trying FODMAPs foods, and also whether it’s okay to eat a little (say avocado or something) if I think I can handle the symptoms. But if that will interfere with healing every time, then I’d like to stay away and speed the healing process!

    • MGH says

      Ceejay, check out http://www.scdlifestyle.com for some good information and potential help with your issue. SCD is very similar to GAPS (GAPS is actually just a more focused version of SCD), and Jordan and Steve are very helpful in explaining individual differences and how to tailor the diet.

      Chris, thanks for the great article. Hopefully my fiancee reads it and cuts me some slack in our stressful wedding planning!

  4. says

    A relaxation method I would like to mention is autogenic training as it is not that well known outside of Germany. In the beginning it may take half an hour lying down in a quiet room to get into a relaxed state, but with practice you can relax in just a few minutes almost anywhere. Just say to yourself a few times while breathing out: “relax”, “heavy”, and “warm” and you are relaxed.

  5. patty says

    I am confused about the” cod liver oil” mentioned above. A prior article of yours recommended “fermented cod liver oil”. Is this the same thing, and is one better than the other?

    Also, if you take cod liver oil, fermented or not, is that a replacement for “fish oil” or “salmon oil”? I know you don’t recommend “fish oil” is that true also of “salmon oil”?

    Additionally, in one of the comments you mentioned that one fighting an autoimmune disease may want to take “fish oil”. Would “salmon oil” be preferred in that case? If it is for anti-inflammation, would curcumin be preferred instead of the fish or salmon oil?

    Yep, thoroughly confused on all this fish/salmon/cod liver-fermented or not, oil!!! Help!!!

    • Chris Kresser says

      Fermented cod liver oil is recommended because it’s cold-processed, which won’t destroy the fragile fatty acids. Salmon oil is an acceptable choice if you’re not able to eat salmon or other cold water, fatty fish – but eating whole fish is preferred (along with reducing intake of omega-6 fats). Improving the omega-3:6 ratio will reduce inflammation.

  6. Sam says

    I know this is true. I have struggle with anxiety/depression for 10+ years and started having all kinds of digestive issues about 8 years ago. After trying several relaxation techniques and some supplements I finally gave in and went on Paxil. Within 1 month all my digestive symtoms were gone so I know stress/anxiety is the source of my digestive problems. After about 1 year I got went off Paxil and all the digestive troubles (along w/ anxiety) came back. I am still in search of a natural cure for this. I have been strict Paleo for several months but I don’t feel much different. I will look into the techniques mentioned in this article. Thanks

  7. EmCee says

    As a person who was continually abused as a child I can tell you that the gut sure does get stuffed around when stressed! I was taken to hospital many a time for suppositories to clear me out from severe constipation. I ate a ton of healthy foods back then, ran around like any child did but the fear of being hit etc made me feel my gut clamp up. As an adult and now a parent my teen goes through some horrible anger management issues and when he flares up (usually due to too much gluten and sugar funny enough!) my stress levels rise again. I am hypothyroid and gluten intolerant (both proven) and my thyroid tests always show a bad result when I have been overly stressed. Interesting, hey! I do wonder if the continual stress hormones from a very young age created the gluten intolerance. Then again, I wonder if it is hereditary as my son has obvious tummy issues and tells me he feels ‘crap in the brain’ eating it too. Trying to eliminate gluten from his diet is almost impossible. He is now nearly 19 and buys rubbish food himself. So I DO see the connection of tummy gut pains and other issues with stress. When I am not stressed my tummy looks flat (and I don’t break wind as often, lol!), when I am stressed I look huge! Great article, Chris!

  8. says

    I have long time struggled with gut issues and been aware of the relationship of stress. Rest Assured is part of the Sounder Sleep System created by Micheal Krugman. I attended a 3 day workshop of his system a few years ago and fixed my chronic sleep issues in just a couple months. Of course, the rub is that you MUST do some daily practice in order to get results and change your stress and arousal levels. As Chris said the practice can be effective in very small doses but often if you are hyper aroused it is a real challenge to be patient and quiet the mind when you are new to it. Frustration sometimes creates a negative association with relaxation. Finding someone who can help create that relaxed environment and use breath or movement to become mindful is a huge help to quiet the ever busy monkey mind. There are Sounder Sleep teachers all over the US (and world). Feldenkrais classes also focus on awareness and help reduce stress. It helps so much to get support when you are serious about changing a habit. And stress, while is an aspect of part of the modern world, is just another thing that we can make choices about just like diet. P.S. Krugman would be a great podcast guest!

    • Chris Kresser says

      I’ve trained with Michael as well, and he is a friend. My wife Elanne is a Feldenkrais practitioner, so I have great respect for that work!

  9. Amanda says

    Hello and thank you for addressing this topic. I deeply appreciate your inclusion of links to the Body Scan method of stress reduction, but I wonder. When I clicked on the link embedded in the word “here,” I was taken to the BuddhaNet site and a long list of sound files. I would love to know which file you were referencing by “here.”
    Reading your site has been very edifying and I am so glad you take the time to really explain things to your readers. I hope you will continue and thrive.

  10. Karen says

    This is so true in my experience, although I wonder what you think about the theory that worrying overly about what you are eating causes such stress much food ends up virtually indigestible – I personally have no major health problems but a history of eating disorders and a tendency to neuroses over food, yet the stricter I become with my diet the more stressed I am and the more stomach distress I experience. I have decided that (within reason) relaxing my rigid dietary rules, allowing the odd slice of sourdough, cup of coffee, glass of wine, square of dark chocolate etc allows everything to digest fine. Of course this is all within the parameters (mine!) of WAPF at the more relaxed end, strict paleo at the rigid end, not exactly SAD anyway you look at it!
    Also, do you know much about the Alexander technique? I had lessons between the births of my two children and now am considering taking it up again as I have a weak lower back but it also helped tremendously with stress management, relaxation, breathing and I’m sure digestion.
    An excellent article and nice to see someone thinking further than just dietary tweaks.

  11. Dan M says

    Hi Chris, I’m writing to get some help with regards to my girlfriend Sasha who has been suffering from symptoms such as stomach cramps and pain and nausea, generally exacerbated by eating, as well as general tiredness and feeling weak and faint, for about the last year. (prior to that she had never had much in the way of stomach problems and it seemed to begin with what appeared to be a stomach bug which lasted for a couple of weeks and then settled but never fully went away and then recurred another couple times over the next few months) She was a vegetarian for about the last half of her life and she is 20 now. I helped her change to a reasonably strict high fat low carb diet of meat and seafood and vegetables and cheese and butter and eggs and raw milk prohibiting all grains except for some white rice and including some starchy veggies. That has appeared to help a lot however she still feels some tiredness and weakness and some less serious stomach issues. She has gotten some blood tests. The results showed high prolactin of 1031 mIU/L, high Eosinophils of 0.8 risen from 0.2 x10^9/L the year before, crp seemed ok at <1 mg/l, and TSH seemed ok at 2.12. everything else appeared to be within the generally accepted healthy range, for wherever that's worth. I feel as though it may be a gut issue, possibly even an infection of some sort, however I'm a little confused about the relevance of the high prolactin. Do you think you could explain this situation to me further please. Thanks in advance, Dan m.

    • Chris Kresser says

      Dan: it’s impossible (and irresponsible) to diagnose someone over the internet. I’d advise your girlfriend to seek help from a qualified practitioner. With high eosinophils, parasites should be ruled out via a DNA/PCR stol analysis from a lab like Metametrix.

  12. says

    This is a really great article! I eat 90% Paleo currently but found out this week that I have intestinal metaplasia and am not sure what adjustments I should make to my diet to reduce my risk of gastic cancer. My gastro says diet doesn’t matter that much, that my genetic predisposition to this type of cancer is a larger factor — I’m not buying it!

    Do you have any resources for nutrition when you have precancerous cells? I’m lost!

  13. Lamar Johnson says

    Thanks for the post. It really helps to understand the complex interactions and some of the whys of stress. I’ve definitely been trying to reduce my stress and I have a few friends that are really going through trying times. Thanks to you I am able to offer more than just supportive words.

  14. Dan M says

    Thanks Chris, of course I realize you are not able to make any kind of diagnosis, but just for the sake of discussion, and without knowing all of the required information, what are some of the things you would be looking for with regards to raised prolactin? Is it something that can have any connection to gut health generally? Also, is it still possible to have problems with your thyroid if your TSH seems to be optimum? Can eosinophils be raised simply because of a bacterial infection or is it generally more specific to parasites? Thanks Dan M

  15. Dan M says

    Hi Chris,

    What are your thoughts on DVT, and its relationship to inflammation, a primal diet, and the use of Warfirin? Do you know ,how this might relate to a high CK reading, low zinc, and maybe thyroid and Cholesterol. Hope this question isn’t too broad. Do you know of anyone who has done some valuable research in this area?

    Thanks Dan M.

  16. Riddled says

    Hi, good stuff thank you.

    I have had digestive and skin issues for years now, i always feel are connected [gut feeling - can't resist] but i can never make the actual connection. I have also had anxiety type issues my whole life although not serious and never needed to be treated, just getting stressed easily, sweating when i’m tense etc, getting angry very easily, having trouble turning off etc.

    Nice to see a connection being made.

    Anyway, i usually take cod liver oil on and off [poor quality but can't really afford the good stuff atm] and vit d3 when its colder. But i have always had bad experiences with probiotics, as in they make my skin worse ie make my acne worse not better.

    |I have tried all types, ie shop bought yoghurt, home-made yoghurt, sauerkraut [home-made], supplements. My skin seems to be a good indicator to the quality of the probiotics, ie supplement sod the least damage, followed by shop bought yogurt, with home-made sauerkraut being the worse giving me large nasty spots i don’t even normally get.

    Also i have a lot of problems with gas, being caused by what i thought were healthy foods, i think mainly from the fibre. I thought fibre was prebiotic so maybe that is the connection.
    The worst offenders for gas [farting/trumping ] are:
    Raw carrots.
    Cabbage.
    Broccoli [all brassicas i think]
    Potato and sweet potato/yam skins
    Rye crispbreads
    Legumes
    |I think fruit although i haven’t eaten it for a long time out of some kind of fructose phobia [mental illness probably - although does give me bloating]

    I realise not all of the above are “healthy” but when i try to eat “healthy” i tend to eat a lot of brassicas and potatoes, carrots and yams as my carb source for exercise. In the end i usually just give up because of the farting/trumping.

    I have also noticed that tomatoes and large amounts of starch, starch+tomatoes, gives me GERD. Seems i can only digest so much starch. Worst offender being normal potatoes. Not really relevant to my post anyway.

    What’s weird is the foods i can seem to digest the best also seem to be the most “unhealthy” – ie: sugar, all dairy. reasonable sized portions of processed white wheat products [ bread, pasta etc ], white rice. I digest not to large amounts of meat and eggs fine i think

    The longest i have stuck with probiotics is a month but i had to stop them because my acne got too severe to live with. What you say makes sense but what with my troubles with fibre and probiotics i’m at a loss of what to do about it.

    I’m considering a zero residue diet out of desperation although i realise conventional wisdom says this can’t be very good for me

    I’m grateful for any help and suggestions. Cheers.

  17. Marty says

    Was in a high stress job. Exec chef in large kitchen. Diagnosed with late stage stomach cancer in 09. IMO stress kills..

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