“As a people, we have become obsessed with Health. There is something fundamentally, radically unhealthy about all this. We do not seem to be seeking more exuberance in living as much as staving off failure, putting off dying. We have lost all confidence in the human body.” 

-Lewis Thomas, The Medusa and the Snail


Today’s post is a bit of a departure for me. I won’t be focusing my attention on gut flora, or intestinal permeability, or tight-junction proteins, or toll-like receptors, or cytokines or any of that.

No, what I want to discuss is something that has been nagging me for quite a while now, namely the effect mental distress often has on digestive wellness. On October 13th of 2013, I published a post on the intimate connection between psychological stress and the onset of gastrointestinal disorders. I concluded that post by writing:

“The intense stress response and increased gut permeability seen in these soldiers is similar to what many people experience, albeit under far different circumstances. From the recently widowed, to the parent who just lost a child, to those undergoing a romantic breakup, to people experiencing financial hardship, to those employed in dangerous civilian occupations—stress can easily set in motion a cascade of physiological responses that can increase intestinal permeability.

The big reason sensible exercise, meditation, having a pet, being in a loving relationship, getting a good night’s sleep, etc. are all good for you is because these activities and social relationships reduce stress and the risk of developing a leaky gut and chronic endotoxemia. Knowing what we know about the negative impact psychological stress has on the gut and gut flora composition in both animals and humans, it’s imperative that we find effective ways to deal with this stress as well as nurture and care for the beneficial organisms that keep the gut wall intact and us healthy.”

I take nothing back from what I wrote then. If anything, I’m more convinced of this now than ever before.

What’s prompted this post is the consulting work I’ve done over the past year or so. I can honestly say that I’ve enjoyed every session I’ve had with my clients. I’ve learned a lot and hope I’ve been able to return the favor.

But I must admit to feeling a tad frustrated at times. And the reason I say that is because I know that I often fail to fully grasp the psychic condition of the people I speak with.

It’s barely possible to fully cover the history and symptoms of someone battling gut dysbiosis in an hour, let alone engage in an in-depth discussion of how the various aspects of their life may be affecting their health. And truth be told, I’ve met with some subtle and not-so-subtle resistance whenever I try to broach the subject.

I get it. You didn’t pay me to discuss problems you may be having with your spouse or children or boss or career or whatever. And trust me, I don’t feel particularly comfortable asking these questions when time permits because I don’t want to get off on the wrong foot during our brief time together.

Be that as it may, none of us are capable of compartmentalizing the way we experience life and how that registers physically. The body just isn’t designed that way.

During most of my consults I make it a goal to engage in some levity, and the reason I do so is because I’m a firm believer that laughter is incredibly effective medicine. Joy is very often absent in people battling gut dysbiosis, and I feel duty bound to offer some emotional relief.

Now one reliable way of doing that is by recounting my experiences with the medical care system when my dysbiosis was at its worst. I explain how I repeatedly had blood drawn for lab work, submitted stool samples for analysis, underwent an ultrasound, had my stomach area palpitated on numerous occasions and was probed in ways I’d rather not reveal only to be told that nothing out of the ordinary was discovered.

It was at this point in my medical odyssey that I demanded a referral to a gastroenterologist in the hope that maybe a specialist could discover something that my primary-care provider had missed. As it turned out, my experiment with garlic made that appointment unnecessary and I never did undergo further testing.

But right before that referral was made, I remember my doctor asking me whether anything was negatively affecting my life that could explain the gut problems I was going through, and if so, did I want a referral to a psychiatrist? I recall telling him in no uncertain terms that the number one stressor in my life was my flip-flopping gut, and that no, I didn’t want a psychiatric referral, but thanks for the offer.

In my mind, however, I was actually thinking: “F*%k you and your referral to a shrink, just fix what’s wrong with me!” But I would never say such a thing out loud because my mother—God rest her soul—raised a very nice and respectful son. This last bit often elicits laughs from my clients that are a pleasure to hear on my end.

But you know what?

My physician was totally justified in asking that question. And the reason is because of what science has revealed about the gut-brain axis.

We have a mountain of well-designed research in both animals and humans verifying the existence of this axis and the role gut flora play in it. One book on the subject published just last year, Microbial Endocrinology: The Microbiota-Gut-Brain Axis in Health and Disease, clocks in at 436 pages and is full of very detailed research on this very topic.

And since that book was published many more scientific papers, including the paper I blogged about on October 28th, continue to confirm this connection. In fact, research findings on all aspects of the gut microbiome are leading to not only a monumental, once-in-a-lifetime paradigm shift in the practice of medicine, but also in how we view and treat mental distress.

Now, while I own a copy of Microbial Endocrinology I would be lying if I told you I’ve read the book from cover to cover. I haven’t. I use it more as a reference and concentrate on those chapters that aid me in writing this blog or in assisting those I speak with.

But what I have read confirms that the gut-brain axis is most definitely not a one-way street. Not only do gut microbes influence mood and mental functioning, thoughts and the emotions derived from those thoughts influence the microbiome and gut health. As such, gut problems can be caused and perpetuated by psychic pain.

Now this isn’t always the case, of course. It certainly wasn’t true for me, and I’m not unusual in that regard.

Once my dysbiosis was dealt with and certain dietary changes instituted, many of the mood and sleep disorders I suffered from went away never to return. And my stress levels declined precipitously as well. So by no means am I implying that everyone afflicted with gastrointestinal distress needs to seek out a mental health counselor or read a self-help book.

In this case correcting dysbiosis via dietary change and the use of antimicrobials, antifungals, probiotics, prebiotics, etc. is highly effective and entirely rational.

But I suspect that for many others this is never going to be enough. Why? Because the circumstances they live under, whether in their personal or work life, are sabotaging any chance of taming a rebellious digestive system.

The gut is second only to the brain in the number of nerve cells it contains. Stephen Colbert’s conservative alter ego wasn’t too far off the mark when he jokingly claimed to navigate life by thinking mostly with his gut. And because of this, the gut very often reflects what your conscious self may be trying desperately to forget or deny.

From the professional athlete or artistic performer who vomits right before every public appearance, to the unhappy individual suffering from gastrointestinal complaints because they’re trapped in a loveless marriage or in a career they’ve come to despise, the brain’s ability to negatively affect the gut in myriad ways is truly remarkable. The world, especially the Western world, is chock full of stressed out, unhappy people living lives of quiet, and not-so-quiet, desperation who feel that they are being devoured from the inside out, and in a way they are.

So let me ask you this: Are you one of these people?

Is your gut trying to tell you something that you may be in denial about? As the saying goes, denial ain’t just a river in Egypt! Nor, as we now know, confined solely to the mental realm.

Look, I’m the last person in the world to claim that psychological stress is the major cause of gut dysbiosis. I’ve spilled far too many words on this blog detailing the numerous ways gut flora can become disturbed via diet, drugs, immune suppression, etc. to argue otherwise.

But I would be doing all my readers a huge disservice if I did not bring up the importance of psychological stress in gut health. I never, ever want to be accused of downplaying this very important factor.

We’ve all heard the saying that stress kills. There’s plenty of proof of that adage everywhere you look. And as I explained here, it mainly has to do with the immune suppressing actions of the stress hormone cortisol, including suppression of that part of the immune system tasked with keeping pathogens—bacterial, fungal and viral—at bay and under control in the gastrointestinal tract and liver.

Most of us who intensively study gut flora, including those who spend their lives researching the microbiome for a living, are still in the dark when it comes to fully understanding how psychological stress and unhappiness affects this internal community. There is much research left to be done in this area. Yet there is little doubt in my mind that unhappiness can lead to disordered gut flora.

So for those of you who’ve consulted with me, or who are contemplating doing the same in the future, or who just come here to read my musings, please understand that gut health is much more than what you put or don’t put in your mouth. Yes, probiotics, fermented foods, prebiotics, dietary modification, exercise, etc. are all important to achieving good health. But so is fulfilling work and loving relationships and believing you’re making a positive difference in the lives of others, however small that might be.

Health is not a thing, but a process; one that encompasses the entirety of the microscopic rain forest that calls our digestive tract home, and the web of human and social relationships that envelope us all. Any view of health that fails to grasp that fundamental reality is, and will forever remain, woefully incomplete.

If you are not living the life you want, and you suspect this may be negatively affecting your health, digestive or otherwise, then I implore you to face up to this reality and do what you can to change your circumstances. You might pleasantly find that the chronic gut problems that plague you might, just might, begin to resolve.

And please do not discount seeking the services of a therapist or spiritual adviser should you feel the need to talk to someone. There are legions of kind and empathetic people out there ready to help you sort out the next chapter in your life’s journey.

Let me end this post with a quote from psychologist Mihaly Csikszentmihalyi’s book Flow: The Psychology of Optimal Experience:

“What I “discovered” was that happiness is not something that happens. It is not the result of good fortune or random chance. It is not something that money can buy or power command. It does not depend on outside events, but, rather, on how we interpret them. Happiness, in fact, is a condition that must be prepared for, cultivated, and defended privately by each person. People who learn to control inner experience will be able to determine the quality of their lives, which is as close as any of us can come to being happy.

Yet we cannot reach happiness by consciously searching for it. “Ask yourself whether you are happy,” said J. S. Mill, “and you cease to be so. It is by being fully involved with every detail of our lives, whether good or bad, that we find happiness, not by trying to look for it directly. Viktor Frankl, the Austrian psychologist, summarized it beautifully in the preface to his book Man’s Search for Meaning: “Don’t aim at success—the more you aim at it and make it a target, the more you are going to miss it. For success, like happiness, cannot be pursued; it must ensue…as the unintended side-effect of one’s personal dedication to a course greater than oneself.”


Until next time…






2 Thoughts on “Stress And The Gut

  1. David on 11/16/2015 at 7:44 pm said:

    It seems to me that too many people are looking for a silver bullet to solve their problems, to deal with whatever is bothering them. Then they can go on living their life as they have before.

    Yet it is the life they lived before, or the accumulated damage from living that life, that is often the cause of the problem. The real solution is to look at your body and life holistically, and that includes the mental, spiritual and emotional sides as you say.

    Good article!

  2. rjmedina on 11/16/2015 at 7:59 pm said:

    I agree. And gut problems can be especially vexing to solve precisely because of this intimate connection between mental state and the GI tract.

    It can be very difficult for any practitioner to truly help a patient without really knowing what may be happening emotionally in that person’s life. And it can be equally difficult trying to get that same patient to understand why this might be a factor.

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