Yes, stress can cause bloating. Here’s what to do
Stress, anxiety and bloating. This seems to be a combination that often comes hand in hand.
Very commonly, when someone is experiencing digestive symptoms of bloating, but also other symptoms of IBS (irritable bowel syndrome) such as cramping or constipation, these more emotional symptoms are present.
Can stress cause bloating or is it that the digestive symptoms are causing the stress?
Often, it’s both. (Source: https://www.express.co.uk)
Anxiety can be felt in the stomach in a number of ways. For many it can feel very different to the typical feeling of IBS (irritable bowel syndrome) but for other it can be very similar.
It can commonly be described as;
- Feeling of butterflies in the stomach
- Cramping in the abdomen
- Nausea or feeling the need to be stick
- Alteration in bowel patterns.
Stress and anxiety are so common in our lives in the 21st century that we might not always be aware of them. Daily challenges, endless emails, traffic jams, they all contribute. The issue with these stressors becoming normal is that we stop noticing them. Our brains tune them out.
A very common theme for those with digestive symptoms is that they feel the stress in their gut. This often happens before they feel the stress emotionally. The daily stresses can impact our digestive function through various pathways and it’s the bloating or churning feeling in the stomach that can be the first warning sign of our stress levels.
This happens mainly through the gut-brain axis. This is a communication pathway that runs between the brain and the digestive system. The role of this pathway is to monitor and integrate gut functions as well as to integrate the parts of the brain responsible for emotional and cognitive function.
When under stress or feelings of anxiety begin to rise, our limbic system (the region of the brain with responsibility for memory and emotional responses) becomes activated. Once activated, this then signals to the adrenals glands to release the hormone cortisol.
Cortisol has many roles. These include altering metabolism to increase the energy available to escape the perceived threat. As well as increasing heart rate and respiratory rate, again to provide higher levels of oxygen to power the escape. This is what we would consider the “fight or flight response”. (Source: https://www.ncbi.nlm.nih.gov)
The fight or flight response is triggered by feeling under threat. When feeling threatened we are left with 2 options. To either fight the threat or to run away from it. In primal terms this is the lion in the jungle that’s chasing us, but in modern terms this is the 100 emails in your inbox. The situation with the lion would typically be over within 5 minutes, you’d either become lunch for the lion or you’d escape. With the modern stresses such as email they can be present for years, day in, day out.
Within the gut, cortisol has several negative impacts which can lead to bloating. Many of these negatives come about through a disruption in our gut microbiome, the trillions of beneficial bacteria within the gut.
Due to environmental stresses being interpreted and a life-or-death situation by the brain, all process called as non-essential for survival have their blood flow reduced. All processes classed as essential for survival have blood diverted to them. Into this category goes the large muscles used to power our escape. The digestive system is in the first category.
The body thinks, “we can worry about digestion when we’re safe” and puts it on pause.
This reduced blood flow, if chronic, can impact bowel motility, leading to reduced motility in the small intestine, which may then lead to bacterial imbalances developing.
High levels of stress and the cortisol that are products can also impact our gut lining leading to increased intestinal permeability, also known as leaky gut. Here, the junction that connects the cells that line the gut lose their integrity, leading to certain compounds entering the blood stream.
Most notably, the LPS component of the bacterial cell wall, once in the bloodstream, has been highly associated with anxiety, stress and depression. (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736941/)
Stress and sugar consumption are also linked which can then contribute to bloating. Specifically, the consumption of high amounts of refined carbohydrates can alter the microbial balances in the digestive system, leading to a reduction in resilience to stress. (Source: https://pubmed.ncbi.nlm.nih.gov)
This can be exacerbated as commonly during period of high stress or anxiety, foods higher in refined and processed carbohydrates are often consumed. The consumption of sugar improve feelings of anxiety in the short term, however, in the long term, it can lead to microbial disruptions, over consumption of processed food, altered sugar metabolism and a reduced capacity to deal with stress. All of which can lead to further microbial imbalances and lead to digestive symptoms such as bloating. (Source: https://pubmed.ncbi.nlm.nih.gov)
The issue is that even a short amount of stress can alter the balances of bacteria in our digestive system. Even once this stress has been resolved the imbalance may still remain.
One of the main roles for these bacteria is to help us digest food, however, when the balances of the bacteria are impacted so is our digestive capabilities. This can lead to the maldigestion of certain carbohydrates which then leads to excess gas being produced, the most common cause of bloating.
The definition of bloating may also be worth clarifying at this point. Strictly speaking bloating is the sensation of pressure within the stomach, whereas the visible inflation of the abdomen is referred to as distention. While they can appear in isolation it’s more common for them to happen at the same time.
Stress, as well as poor sleep which often results from stressful life events, contributes to visceral hypersensitivity. This is heightened response to pain by the nerves within the gut, ie, they become overly sensitive. This means that stress can increase the sensation of bloating without their being more gas produced within the gut (Source: https://www.ncbi.nlm.nih.gov)
While it may not be possible or easy to do, ideally, we want to address the stress that is contributing to the bloating. This may be the root cause for many.
However, as mentioned above, following periods of stress we can enter a vicious cycle. Here the imbalance in the gut microbiome makes us more sensitive to stress and then the additional perception of stress can then further disrupt the gut.
In these cases, it can be most helpful to address the imbalance in the gut and the perception or exposure to stress at the same time.
There are several tools and approaches to use to help rebalance this.
Diaphragmatic breathing is a key component for calming the central nervous system. This is also known as belly breathing and involves activating the diaphragm by, you guessed it, breathing from the belly. When in times of stress or anxiety we can see that our breathing changes from deep belly breaths to breaths that are shallower and originate from the chest. These shallower breaths can almost be seen as a mild form of hyperventilation, further activating the fight or flight response and contributing to bloating.
Breathing from the diaphragm helps to activate the main nerve that connects the gut to the brain via the gut-brain axis. This nerve, known as the vagal nerve, if stimulated in the appropriate manner though breathing, can help to move us from the fight or flight part of the central nervous system and over into the calming rest and digest part. (Source: https://www.ncbi.nlm.nih.gov)
One of my favourite parts about breathing practices is that the breath is something that’s always with you and it doesn’t cost a penny.
Here is a video guide on how to carry out diaphragmatic breathing.
2 key tools that have been shown to help support the gut and the stress response are probiotics and prebiotics.
When we refer to these tools, they can be defined as;
Gut Support Tool One: Probiotics
Probiotics are live microorganisms which upon ingestion in sufficient concentrations can exert health benefits to the host. (Source: https://www.ncbi.nlm.nih.gov)
Gut Support Tool Two: Prebiotics
Non-digestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, and thus improves host health. (Source: https://www.ncbi.nlm.nih.gov)
Key combinations of beneficial bacteria have been shown to help improve the stress response (Source: https://pubmed.ncbi.nlm.nih.gov/25862297/) as have specific forms of prebiotic fibres, such as galacto oligosaccharides (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410136/).
While specific types of prebiotic fibres in supplemental form can help support the gut and the stress response but feeding key species of beneficial bacteria and supporting the gut lining. Additionally, the range and quantity of plant fibres in the diet has been associated with a reduction in levels of stress and anxiety. These are two key factors that can contribute to bloating.
However, if someone is experiencing bloating very frequently, it may be best to avoid specific fibres which commonly contribute to increased gas production. These are commonly referred to FODMAPs.
Even if certain foods are restricted, it’s important to keep the diet as diverse as possible. Two aims to keep in mind are;
- Aiming for at least 30 different plant foods a week. These plant foods include fruits, vegetables, herbs, spices and herbal teas.
- Aiming to eat each colour of the rainbow every day. Thinking about reds, purples, yellows, oranges and greens.
The aim here is to have the diet as diverse as possible to support a diverse gut microbiome.
Key calming herbs can also be helpful. The following are commonly available in tea or supplement form and may be the most useful under periods of acute stress.
- Lemon Balm
Additional herbs that can be helpful may take a little while longer to build up within the body to support the stress response. These are classed as adaptogenic herbs which means they help the body to adapt to stress. The key adaptogenic herbs I find helpful in my practice are;
- Siberian Ginseng
Additional ways to support the gut-brain axis are through practices such as CBT (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530860/) or gut directed hypnotherapy.
Both of these practices can be helpful with cognitive restructuring. This is a key skill to develop when addressing symptom-related anxiety and hypervigilance and aims to increase the individual’s awareness of how their thought processes and patterns influence their symptoms of bloating.
By identifying thought patterns and how they may trigger the fight or flight response, cortisol release and hyperarousal of the gut, these patterns can be adjusted to lead to an improvement in symptoms.
There are many terms we already use to describe the symptoms of stomach stress. We probably use these without even realising it.
Terms such as ‘gut feeling’ or ‘butterflies in the stomach’, can be key indicators that stress is building up. Often, as already mentioned, the first we may be aware of the stress we’re experiencing is when our stomach turns over.
If the stress passes, then so will this sensation. However, chronic and ongoing stress can lead to disruptions that may last long after the stress has subsided.
The sensation of bloating and the visible distention can worsen during these periods of stress. Other digestive symptoms such as reflux (heartburn) and altered bowel patterns (constipation and diarrhoea) can also occur.
Bloating rarely comes in isolation and can often be attributed to imbalances in the microflora, which can be caused or worsened by daily life stress. During prolonged periods of stress gut microbiome diversity is impacted. (Source: https://www.sciencedirect.com/science/article/abs/pii/S0889159118312145)
Gut microbiome diversity is a key indicator over the health of the microbiome. Once diversity of key bacteria is lost then the function of the entire ecosystem is impacted.
This may then lead to:
- Increased risk of digestive issues such as IBS
- Increased risk of inflammatory bowel conditions such as Crohn’s and Ulcerative Colitis
- Disruption of the gut-brain axis and the stress response. For example, increasing how sensitive we are to stress.
- Increased risk of metabolic conditions such as type 2 diabetes and obesity
Stress is one of the most common and under-acknowledged factors is modern life. In our culture it can almost be glorified along with how busy we are.
The cultural norm of stress is something that can make it hard to identify and due to social pressures, something that’s hard to address. Understanding our individual stress triggers and when and where we’re exposed to them is a key component to support both our emotional health and our digestive health.
It is often the case that both areas need supporting. Our emotional health with a caring and nurturing approach to ourselves through stress management and self-awareness practices. Our digestive health through a diverse and colourful diet, use of specific supplements and potentially restricting specific foods that may worsen bloating.
There are however key strategies, as outlined above, that can help increase our resilience to stress and improve the health of our gut.