The Gut-Brain Axis and IBD

I've talked on here before about how IBD can impact your mental health and why we need to do more to support patients with it. But new research has emerged as to why so many of us with IBD may struggle with things like anxiety (other than the fact racing to the nearest toilet is hugely stress-inducing).

According to the Crohn's and Colitis Foundation, people with IBD are 2 to 3 times more likely to suffer from anxiety and depression, compared to the rest of the population, with factors such as smoking, previous surgery, and extra-intestinal manifestations increasing the risk even more. These mental health issues also seemed to impact IBD: IBD patients with anxiety and depression were more likely to be hospitalised, took steroids more frequently, and were on biologics – although this suggests a correlation rather than a cause.1

However, new research has suggested it is the gut-brain axis that plays a part in it.

What is the gut-brain axis?

The gut-brain axis is a link between our central nervous system and our enteric nervous system, which governs the function of our digestion tract. Therefore, it's essentially the system between the gut and the brain and how it communicates.

There are millions and millions of neurons in our gut, which then are connected to your brain through nerves in your nervous system. One of the biggest nerves is the vagus nerve, which is responsible for sending "messages" back and forth in both directions.

IBD flares, anxiety, brain fog

However, a recent study found that when studying animals and IBD, inflammation in the digestive tract when flaring may essentially cause an important "gateway" to close. The study concluded: "...we observed a deficit in short-term memory and anxiety-like behavior, suggesting that PVB closure may correlate with mental deficits. Inflammatory bowel disease-related mental symptoms may thus be the consequence of a deregulated gut-brain vascular axis."2

So this could indicate that this closure caused things like anxiety and brain fog in those with IBD and it may be this altered gut-brain axis rather than other things such as fatigue or even medication that causes mental health issues in those of us living with inflammatory bowel disease.

Gut-brain hypotheses from an IBD dietician

"It's very difficult to differentiate between the physical changes to our gut-brain axis and the psychological impact of living with IBD In the first place, which can be very stressful," explains Sophie Medlin, dietitian and Chair for the British Dietetic Association for London, who specialises in gut health and IBD.

"The more we learn about the gut-brain axis, the more we can learn about the impact of Crohn's and bowel surgery on our mental health," Medlin said. "It's incredible to think that our brain has the ability to shut down the channel of the communication between the gut and the brain to protect the brain from inflammation that's occurring in the gut, it's more exciting to understand more about this area."

She added, "We know that 70% of the total body serotonin – the happy hormone – is stored in the gut so it stands to reason that when this connection is severed, we may struggle with anxiety and depression. Improving serotonin levels may become common practice when people are suffering from IBD flares, as we can understand how we can protect people better and improve their mental health when suffering from the condition."

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