DEAR DOCTORS: Sometimes when I get nervous, my stomach will knot up and start to ache. Sometimes I even get diarrhoea, which is embarrassing. Why does that happen? Should I see a doctor? I'd like to know about any natural remedies that might help, and also any medications.
DEAR READER: Tell someone you've got butterflies in your stomach, and it's likely they know how you feel. It's part of a connection between emotion and the gut that has been recognised for millennia.
But for some people, the physical response to certain emotions, including anxiety, is far more pronounced. Rather than just a few flutters, they experience symptoms that can become severe. The stomach pain that you have described, as well as the spasms, are common in such cases. Additional symptoms can include loss of appetite, unusual hunger, indigestion, flatulence, diarrhoea, constipation and nausea.
This syndrome goes by the name of anxious or nervous stomach and is believed to be linked to our fight-or-flight response. The reason it becomes more pronounced in some people is not fully understood. However, recent research increasingly points to the workings of what is known as the gut-brain axis. This refers to the complex networks of nerves that connect the gut and the brain.
Biochemical signals in the gut-brain axis run in both directions. They link the emotional and cognitive centres of the brain with intestinal function. That means the emotions someone feels can affect them physically, and physiology can affect the emotions. The composition and behaviour of someone's gut microbiome appears to play a role in nervous stomach, as well.
Treatment typically involves a multidisciplinary approach. This includes practices such as meditation, mindfulness and deep breathing to manage stress. Exercises such as yoga and tai chi, as well as weight-bearing exercises, have been shown to lessen susceptibility to stress. This has to become a regular and ongoing part of your life for results to become apparent. Regular and good-quality sleep are important. This applies not just to managing anxiety, but also to general health and well-being.
The link between our emotions and the health of the gut microbiome means that nutrition can play a role. Try replacing added sugars in your diet with gut-friendly fresh fruits, and eat fresh vegetables, leafy greens, whole grains and legumes rather than processed foods. Ginger and peppermint, easily available as tea flavourings, can ease GI symptoms.
There is also evidence that the scent of lavender and lemon balm can have a calming effect. Some people benefit from seeing a therapist or counsellor or joining a targeted therapy group. And in some cases, antidepressants or antianxiety medications may be prescribed.
The stomach aches and spasms you have been experiencing are common to a wide range of gastrointestinal disorders. These include gastroenteritis, lactose intolerance, gastric ulcer and irritable bowel syndrome, or IBS. To be sure that none of these conditions are playing a role in your ongoing symptoms, we think it would be wise for you to see your healthcare provider. Universal Features Syndicate
Dr Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.
