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I'm working with a client who's had chronic anxiety and panic for as long as she can remember. She has a brief history of bulimia, likes her morning coffee and has a hard time saying no to friends who'd like her to join them for a drink.  Last week she landed in the ER with an attack of severe abdominal pain enough to warrant intraveneous morphine and few other mystery painkillers. Her doctor diagnosed her with Irritable Bowel Syndrome and said it was due to her anxiety but I think it's a bit more involved than that which is why I gave you a little background on her history.
Stress, a significant factor in anxiety and depression, is known to alter GI microflora, lowering levels of the good bacteria (lactobacilli and bifidobacterium as well as many other species) which allows the bad or toxic bacteria to proliferate and overwhelm the GI tract. Bacteria in the GI tract transmit information to the central nervous system, whether or not an immune response is involved. This means that there is a cause and effect attribute to both friendly flora (probiotics) and toxic bacteria with respect to cramping, tension, fatigue and irritability, all of which can factor into anxiety, panic and depression.
Our gut produces 95% of all our serotonin, specifically in the small intestine.
Clients who suffer from anxiety and depression have been shown to have elevated levels of pro-inflammatory cytokines, increased oxidative stress, altered gastrointestinal (GI) function, and lowered micronutrient and ω-3 fatty acid status. Small intestinal bacterial overgrowth (SIBO) may be contributing to the limited nutrient absorption and is likely at play if we don't have enough of the good stuff to crowd it out. Under stress the body increases catecholamines, "fight-or-flight" hormones released by the adrenal glands in response to stress and pro-infammatory chemicals such as cortisol which contributes to the suppression of serotonin.
Probiotics have the potential to lower systemic inflammatory cytokines, decrease oxidative stress, improve nutritional status, and correct SIBO. The effect of probiotics on systemic inflammatory cytokines and oxidative stress may ultimately lead to increased brain derived neurotrophic factor (BDNF). This survival-promoting molecule plays an important role in the growth, development, maintenance, and function of several neuronal systems.
Eating disorders certainly create the risk of destroying the baseline level of healthy flora in the intestine. Add in chronic anxiety, some caffeine, alcohol and a socially difficult situation and overtime you've got a recipe for an ER visit waiting to happen.
For clients who are open to incorporating a nutritional protocol into their mental health treatment plan, I refer them to a GI doctor who is has expertise in probiotics (not all MD's are educated or trained adequately in nutrition). Other good referral sources are credentialed nutritionists, homeopthaths, naturopaths, herbalists and acupuncturists. In the meantime, for suffering with abdominal pain in relation to anxiety, research suggests staying away from caffeine, alcohol, insoluble fiber (i.e., raw vegetables, the skin on fruits), foods high in fat, carbonated beverages and dairy products.
Christine Hassell, LMFT
Sources
Reference: McEwan BS. Protective and damaging effects of stress mediators.
New England Journal of Medicine. 1998;338(3):171-179
Nutrition Research Consulting, 50 Yonkers Terrace, 8-J Yonkers, NY 10704, USA
Start Clinic for Mood and Anxiety Disorders, Psychiatry, University of Toronto, 790 Bay Street, Suite 900 Toronto, Ont., Canada, M5G 1N8
Haug MD PhD, Tone Tangen, Mykletun MA, Arnstein, and Dahl MD PhD, Alv A. "The Association Between Anxiety, Depression, and Somatic Symptoms in a Large Population: The HUNT-II Study." Psychosomatic Medicine." 66:845-851, 2004.
Haug MD PhD, Tone Tangen, Mykletun MA, Arnstein and Dahl MD PhD, Alv A. "Are anxiety and depression related to gastrointestinal symptoms in the general population?" Scand J Gastroenterol 37(3): 294-298, 2002.
The John Hopkins University Digestive Disease Library. Irritable Bowel Syndrome, 2008.
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