Stress and IBD

Stress comes in all sorts of different forms - it can be physical, mental, emotional or chemical -  but most of us are exposed to it in one form or another. It’s how we learn to deal with it that’s important. We have evolved to be able to cope with short bursts of stress (such as running away from a lion) and in the modern world a small amount of stress can be beneficial to help us finish a work project or get through an exam. But when that stress becomes chronic - in that it’s there all the time - it can lead to problems.

According to the NHS: “Stress is the feeling of being under too much mental or emotional pressure, and pressure turns into stress when you feel unable to cope. A bit of stress is normal and can help push you to do something new or difficult, but too much stress can take its toll.”1

As mentioned above there are a few different types of stress that we may find ourselves placed under and sometimes you may not even realise that your body is under stress.

Physical stress

You may be placed under physical stress by an illness or disease (such as IBD), intense exercise, working long hours, pregnancy.

Mental and/or emotional stress

You may be placed under mental or emotional stress through a bereavement, breakdown of a relationship, being unhappy in a job, being made redundant, becoming a parent, getting married, being a carer for a friend or family member, retiring, money worries, moving house, depression, anxiety, low self-esteem or other mental health issues.

Chemical stress

You may be placed under chemical stress through a food allergy or intolerance, medication you are taking, toxins you are exposed to.

What is the stress response (aka 'fight or flight')?

Stress is our body’s biological or psychological response to a threat. When our body detects a threat it enters what we refer to as fight or flight mode. Historically we would enter this mode when we were facing a physical threat (such as being eaten by a lion). These acute episodes of fight or flight mode would help us either flee from the threat or stand up to it.

When we become stressed the hypothalamus (an area of the brain that coordinates various systems in our body) sends signals to the pituitary gland (our body’s master gland) and the adrenal medulla (which controls stress hormones). Once these signals have been received a cascade of hormones are released and our fight or flight response is triggered. At this point you may notice increased heart rate, slowing of digestion and increased energy and strength.

Although what is now perceived to be a threat has changed drastically the fight or flight response is still incredibly important - but it may also be detrimental to our health if it is being triggered at the wrong times.

When faced with being hit by a car fight or flight mode can be important in saving us. However, in the modern world our stress response is being increasingly triggered more and more by things such as traffic jams, work deadlines or even just things we read in the news or see on social media.   

It’s thought that this constant activation of the stress response can take its toll on the body which is given no time to recover from the effects of the constant stream of stress hormones. This can result in heart issues, increased inflammation and even lead to chronic disease.

Stress, Crohn’s disease and ulcerative colitis

According to the American Psychological Association2 “stress can make existing problems worse3. In one study, for example, about half the participants saw improvements in chronic headaches after learning how to stop the stress-producing habit of “catastrophizing,” or constantly thinking negative thoughts about their pain4.

”Another study5 found that ‘chronic psychological stress is associated with the body losing its ability to regulate the inflammatory response’ which could ‘promote the development and progression of disease’6. Evidence is also growing that psychological stress contributes to the risk of relapse in IBD7.

It has also been shown in mice that stress affects the structure of the intestinal microbiota8. Our gut microbiota (often referred to us our microbiome) is a collection of organisms that live in our intestinal tract. Researchers are now finding that these organisms have a huge influence over our well-being (or poor health). You can read more about the microbiome and IBD here.

Stress can lead to people losing sleep or becoming anxious or irritable. It can lead to people losing self-esteem, becoming angry or cause physical problems such as heart disease, asthma, stroke, diabetes and some types of cancer9.

It can affect how you think, feel and behave. And, we have already seen above that it affects the body’s inflammatory response and the risk of IBD relapses. These can all have a dramatic effect on your quality of life.

The true effects of modern day stress aren't fully understood, but what is known is that most of us would benefit from even a small reduction of stress in our lives.

Reducing stress

Knowing where to start with stress reducing stress can be a stressful process in itself. We are all different and what works for one person may not work for another, but here are a few suggestions for things that may help you reduce your stress levels.

Meditation and breathing

Mindfulness and meditation can make us more aware of the world around us and help us enjoy life more. There are some great apps out there which can support you to get started, such as Headspace and Calm. Alternatively you could try this simple breathing exercise.

Outsource tasks

Are there any tasks which stress you out that you could ask other people to help you with, or pay someone to do (such as cleaning)?

Exercise

Any kind of exercise, even just going for a short walk, can do wonders for stress levels. Find out more about exercise and IBD.

Lower expectations

This is a hard thing to do but places less expectations on yourself may help you to feel stressed. Does it really matter if the washing up isn’t done or that something isn’t perfect?

Identify your stressors

If you know what stresses you out and then you can face them head on - this can be painful in the short time but better in the long run - or try to avoid them completely. Try keeping a diary of activities and your stress levels to see if you can identify any common themes.

Reduce technology time

Being constantly 'switched on' can cause us unknown stress - whether that's from work emails pinging onto your phone late at night or constantly scrolling through social media. Why not try setting yourself some daily technology free time? This could be at any time that works for you, but many people find the best benefits from doing it just before bed.

Have some fun

Put aside time to do enjoyable things - schedule them into your diary and make sure you do them!


References

  1. Public Health England, https://www.nhs.uk/oneyou/stress#rHPbhhJ8YmV19Rj2.97
  2. How stress affects your life, American Psychological Association
  3. Kiecolt-Glaser, J. & Glaser, R. Stress-induced immune dysfunction: implications for health. Nat Rev Immunol. 2005 Mar;5(3):243-51. doi: 10.1038/nri1571
  4. Thorn, B.E., Pence, L.B., et al. (2007). A randomized clinical trial of targeted cognitive behavioral treatment to reduce catastrophizing in chronic headache sufferers. Journal of Pain 8 , 938-949
  5. Sheldon Cohen, Denise Janicki-Deverts, William J. Doyle, Gregory E. Miller, Ellen Frank, Bruce S. Rabin, and Ronald B. Turner. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. PNAS, April 2, 2012 DOI: 10.1073/pnas.1118355109
  6. How stress influences disease: Study reveals inflammation as the culprit, Science Daily, April 2 2012
  7. J E Mawdsley and D S Rampton. Psychological stress in IBD: new insights into pathogenic and therapeutic implications. Gut. 2005 Oct; 54(10): 1481–1491
  8. Bailey MT, Dowd SE, Galley JD, Hufnagle AR, Allen RG, Lyte M. Exposure to a social stressor alters the structure of the intestinal microbiota: implications for stressor-induced immunomodulation. Brain Behav Immun. 2011 Mar;25(3):397-407. doi: 10.1016/j.bbi.2010.10.023. Epub 2010 Oct 30
  9. Public Health England https://www.nhs.uk/oneyou/stress#rHPbhhJ8YmV19Rj2.97




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