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By Anil Minocha MD, author of Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
Stress is all around and within us. All of us no matter how rich and mighty encounter it in our daily lives.
Types of Stress
Broadly speaking, stress may be physical or psychological. Irrespective of the type, it promptly arouses body’s defensive adjustments/mechanisms to ward off the danger to its “normal balance” of bodily structure and functions in order to ensure its survival.
Is It Leaky Gut or Leaky Gut Syndrome?
Big Brain-Little Brain cooncept
• When we think of our nervous system, we automatically think of our brain the head. Well, that is the big brain.
• Our body also has Enteric Nervous System or the “little brain” which is constantly communicating with our big brain in a bidirectional manner.
• Think of our big brain exercising the overall control over the overall body for its well-being, whereas the little brain represents the local control of the gut.
• Bidirectional gut-brain communications regulate the gastrointestinal function during health as well as sickness. These interactions occur via complex messaging signals include neuronal, immune and endocrine messaging system.
Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
Body Systems Responding to Stress
• We always think of immune responses as well as physical defense reaction as racing heart, sweating etc. as responses to actual or perceived stress
• Our gastrointestinal system is not immune to it and actually participates in numerous ways including but not limited to its own GALT or Gut-associated-Lymphoid-Tissue.
• We have all heard or suffered through diarrhea during exam days, heartburn during stressful conversations.
Effect of Stress-Induced Signals on Gastrointestinal Functions:
• Altered gastrointestinal secretions
• Altered gastrointestinal motility
• Increased permeability of intestinal barrier
• Alterations in blood flow to the gut
• Altered gastrointestinal bacterial patterns: Many of these bacterial changes during result in making the bacterial environment more pathogenic to the body thus making our body more vulnerable to infection.
Is It Leaky Gut or Leaky Gut Syndrome?
How Does Stress Affect Gut:
- The lining of the gut wall and its mucous layer represent a vast communicating milieu for our body, brain and the trillions of gut bacteria in our gut. It acts as a barrier against bacterial infection.
- Conversely the gut’s normal bacterial inhabitants’ as well “foreign” bacteria network with the lining of the gut wall and affect the body’s cellular and immune responses.
- Presence of nerve endings in the gut wall direct provide pathway for bacterial messaging to neuronal circuits that play a vital role in regulating pain and immune-response, modulation, emotions and other body’s higher as well as peripheral homeostatic functions.
- Stressful situations can evoke a wide variety of symptoms as we all know including heartburn, bloating, gas, diarrhea etc. These symptoms don’t occur without any basis. For example, simple situations like heated argument increases gastric acid secretion.
- Any disturbance of brain-gut axis may affect even simple functions like appetite and eating behavior resulting in increased food consumption.
Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
Brain Gut Axis:
- The constituents of this axis include autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal axis (HPA) as well as variety of hormones and neurotransmitters.
- Brain-gut axis is also involved in the “Gut-Clock” or circadian rhythm, disruption of which has been implicated in many gastrointestinal disorders including GERD, Peptic Ulcer Disease, IBD and IBS. It is noteworthy that melatonin improves symptoms in patients with irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and gastroesophageal reflux disease (GERD).
How Does Stress Affect Health and Cause Gastrointestinal Disease
- Stress with its roots in the brain produces alterations in the enteric nervous system (ENS), activation of mast cells and immune responses disturbing the healthy homeostasis of pro- and anti-inflammatory factors including cytokines leading to disease.
- According to Lyte and colleagues (2011) stress messengers like norepinephrine, at the critical crossroad of above factors not only affect the protective cell lining of the gut but also the bacteria especially along the gut wall.
Is It Leaky Gut or Leaky Gut Syndrome?
- Brain signals including stress alter intestinal bacteria via modulation of gastrointestinal motility and secretion, and intestinal permeability directly via neurochemical signals released into the gut lumen from nerve (neuronal message) and immune cells in the gut wall (immune message).
- The neuronal, immune and hormonal messages modulate the balance of pro- and anti-inflammatory cytokines. Stress induced norepinephrine increases virulence of potentially pathogenic bacteria like E. coli and C. jejuni.
- Conversely, gastrointestinal bacteria interact with our body via their interaction with lining of the gut wall (endocrine message) and impact upon gastrointestinal secretions, motility and sensitivity.
- Interference in the bidirectional interactions between the gut bacteria and the brain have been implicated in pathogenesis of several gastrointestinal disorders including functional and inflammatory bowel disorders.
Corticotrophin Releasing Factor (CRF) at the Crossroads of Brain-Gut and Stress:
- CRF receptors are present in both brain and the gut.
- CRF represents the neurochemical signal involved in endocrine system, stress/behavior (nervous system) as well as the immune system.
- Stress causes a CRF release by the by the hypothalamus in the brain CRF in turn causes a release of ACTH from the pituitary. The ACTH activates secretion of cortisol from the adrenal gland.
- CRF mediated interactions play a vital role in gastrointestinal motor function, permeability, secretions, inflammatory response. For example, CRF is involved in stress induced contradictory functions, i.e. slowing gastric emptying while stimulating colonic motility.
- According to Tache and Bonaz from the CURE, Digestive Diseases Research Center, and Center for Neurovisceral Sciences & Women's Health, UCLA, Los Angeles, CA, CRF signaling pathways are the main coordinators of the endocrine, behavioral, and immune responses to stress.
Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
Dr. Minocha's thoughts on GI Disorders Mediated Via Stress-Induced Gastrointestinal Changes:
- Chronic heartburn, GERD
- Peptic ulcer disease
- Functional dyspepsia
- Irritable bowel syndrome
- Inflammatory bowel disease
- Pelvic dyssynergia
