STRESS and the GASTROINTESTINAL TRACT

compiled by Kathy Somers
Stress Management and High Performance Clinic
519 824-4120, ext. 52662

• books
• web pages 
• tips on improving gastrointestinal function and Irritable Bowel Syndrome (IBS)

BOOKS

 I.B.S. Relief. A Doctor, A Dietitian, and a Psychologist Provide a Team Approach to Managing Irritable Bowel Syndrome.   (1998)   by Burstall, D., Vallis, M., & Turnbull, G.
A very good book on diet, eating habits, and assertiveness. It introduces the topics of breathing, muscle relaxation, and imagery for relaxation.

The Wellness Book of I.B.S.   (1989)  by Scanlon, D.
This book is excellent for providing recipes and nutrition ideas. The information on relaxation and biofeedback is brief, such that someone new to relaxation may find it difficult to extract the how-to's.

If This Is a Test, Have I Passed Yet? Living With Inflammatory Bowel Disease.   (1994)  by Sherkin-Langer, F.
This is a good personal account of coping with Inflammatory Bowel Disease.

Relief From I.B.S.   (1988)  by Shimberg, E.
A very well done book, with information on the relationship of I.B.S. to stress, assertiveness, time management, relaxation, and self-talk. Highly recommended.

Behavioral Medicine : Concepts and Procedures.   (1991)  by Tunks, E. & Bellissimo, A.
This book is written for health professionals. Chapter 10 is about managing I.B.S. and related symptoms, and applying cognitive / behavioural principles.

WEB SITES

www.badgut.com is the web site of the Canadian Society of Intestinal Research.

www.ibsgroup.org is the web site of the Irritable Bowel Syndrome Self-Help and Support Group. This online community includes bulletin boards and chat nights.

www.dietitians.ca/eatwell is the web site of the Consulting Dietitians of Canada (phone 1-888-901-7776)

www.canadian-health-network.ca has information on IBS, nutrition, etc.

TIPS on HAVING BETTER GASTROINTESTINAL FUNCTION...

A strong indicator that something is bugging us, or is emotionally upsetting us, is a change in gastrointestinal function. It may be "butterflies", indigestion, frequent urination, diarrhea, constipation, or a flare up of ulcers, Irritable Bowel Syndrome, or other gastrointestinal disorders. Most people are poor observers of the relationship between what they eat, their psychosocial stressors, and gastrointestinal functioning. They take it for granted when things are going well, or make many incorrect assumptions when they are unwell.

Stress, poor eating habits, skipping meals, overeating, and eating too quickly can affect the gastrointestinal tract. Watch out for other triggers that can upset normal functioning. This includes such things as certain foods (eg. milk, ice cream, coffee, alcohol, spicy food, pizza, or too many sweets), lack of sleep, illnesses (eg. flu), weather (eg. heat, barometric weather changes), high stress jobs, arguments, disputes, jet lag, shift work, and medications. It is also important to rule out food allergies, infection, lactose intolerance, hypoglycemia, folate deficiency, candida, gallbladder problems, mal-absorption syndrome, parasites, etc. as the causes for symptoms. Patterns of taking/stopping medications known to alter bowel function can escalate symptoms (eg. some antibiotics, antacids, codeine products, antidepressants, antihistamines, benzodiazepines, tranquilizers, hypnotics, opiates, laxatives, iron pills, calcium, muscle relaxants, and many other medications can upset bowel function).

To improve gastrointestinal functioning :

• Know your gastrointestinal tract : keep a daily record of food intake, when it is eaten, amount of food, food content (eg. nutrients, fibre, caffeine, fat, junk food, and sorbitol sweetened foods such as gum, pop, ice cream), alcohol, cigarettes, medications, laxatives, activity schedule (eg. exercise, sleep, relaxation), bowel movements, gas, abdominal discomfort, cramping, and thoughts & fears about gastrointestinal function.
  See what you learn from these interrelationships and make adjustments accordingly.

• Have a good dietary pattern :

  Eat every 4 - 6 hours. This means having breakfast within 1 - 2 hours of rising. Skipping meals causes the body to release its own stress chemicals in order to mobilize stored energy reserves. For some, this stress response can spark headaches, panic attacks, and/or gastrointestinal symptoms.

  Try eating 6 small meals, spaced evenly throughout the day.

  Avoid skipping meals, eating excessively, or an irregular eating pattern.

  Do not avoid eating because of fears that symptoms may aggravate intestinal symptoms.

• Eat when you are hungry. Learn to determine hunger from the "false hunger" that occurs when you have nervous tension around your stomach.
  How can you tell the difference? Take fifteen minutes and practice a deep relaxation technique to release your physical tension and calm your emotions. If the hunger sensations persist even when your stomach is relaxed and you are emotionally calm, you are truly hungry.

• Drink enough water, juice and milk daily.

• Eat a variety of nutritious foods for a balanced diet. Avoid fad diets and junk foods.
  For a balanced diet, Canada's Food Guide recommends eating a variety of nutritious foods daily :
  
  • fruit and vegetables - 5 to 10 servings per day (the more intense the vegetable colour usually indicates more nutrients)
  • milk and milk products - 2 to 4 servings per day
  • bread, grains, and cereals - 5 to 12 servings per day
  • meat, fish, poultry, eggs, dried beans/peas, nuts/peanut butter - 2 to 3 servings per day
  Canada's Food Guide to Healthy Eating is found at www.hc-sc.gc.ca/hpfb-dgpsa/onpp-bppn/food_guide_rainbow_e.html.

• Ensure that you are getting adequate nutrients when you are under stress.
  Stress depletes your body of such energy and nutrients as : vitamin A, vitamin C, vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B6 (pyridoxine), calcium, and protein.

• Vitamin A helps protect mucosal surfaces of the gastrointestinal tract. Keep in mind that people with colitis do not absorb vitamin A as well as other people. Those with Crohn's Disease have lower vitamin A blood serum levels. The minerals depleted in individuals with Irritable Bowel Syndrome are zinc, magnesium, calcium and selenium.

• Increase fibre gradually. Generally the daily fibre should be 25 grams for women and 38 grams for men.

• Eliminate caffeine. It is present in coffee, tea, pop, chocolate, and many prescription and over the counter cold and pain medications. Caffeine mimics the body's adrenaline stress response. It changes stomach and bowel function in addition to increasing muscle tension, metabolism, heart rate, blood pressure, and changing blood flow and breathing patterns. It is important to wean off caffeine gradually in order to avoid painful withdrawal effects such as headaches.

• Avoid too much fat, saturated fat, cholesterol, salt and refined sugar.

• Limit sorbitol, olein/olestra fat substitutes, and spicy/gassy foods.

• Reduce interference by drugs and laxatives.
  (If you are currently using laxatives, the first step is to establish a balanced diet and regular eating habits, including natural sources of fibre, and eliminate constipating medications. Once this is accomplished, the second step is to use fixed drug doses to gradually wean off laxatives over a 2 week period.)

• Eat slowly and chew thoroughly.

• Take a brief, relaxing walk after meals.

• Establishing a regular pattern of good eating, exercise, and sleep habits will help establish a routine for bowel movements (gastrointestinal rhythms are linked with other body rhythms). However, do not expect a "clock-work colon".

• Reduce stress, especially in some of the following areas :

If you are aware of what event / situation has stressed or upset you, and thus also upset the gastrointestinal tract, take action to eliminate these events or reduce their stress as much as possible.


Practice worry control.

Relax prior to meals. (Use a brief relaxation technique or a longer, deep relaxation technique if time permits.)

Practice 20 minutes of deep relaxation twice a day.


• Use muscle relaxation which includes the abdomen.
• Or use diaphragmatic breathing as it relaxes the body and gently massages the gastrointestinal area.
• Or use Autogenic Training, including the instructions to relax tension in the solar plexus/abdominal area.
• If you would like training in these techniques, consider taking the Relaxation and Stress Management Skills Training Program or teach yourself with relaxation books, cassettes or CD's.

Investigate the possibility of using biofeedback to further develop your skills in relaxation, especially in emotional calming.  The more you can calm your emotions, the more you could lessen your distress.


Decrease all-or-nothing self-talk (such as "I must do my absolute best at everything...").

Reduce self-blame (eg. avoid taking responsibility for negative events you cannot control).

For women it is important to decrease gender role conflicts.

Use assertiveness and time management in order to decrease stress around your stomach. Avoid using too many personal resources to care for others at the expense of looking after your own needs. "Don't let people walk all over you - you might not have the guts for it!"

The items in the above list which are in bold type are especially important components in working effectively with Irritable Bowel Syndrome.

(Let me know other resources that would be good additions to this list by e-mailing me at ksomers@uoguelph.ca .)

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