Published by the Students of Johns Hopkins since 1896
January 29, 2023

It’s not all in your head: the brain and gut connection

By MORGAN OME | November 29, 2018


For as long as I can remember, my stomach has always hurt. Sometimes, I would feel like I was being stabbed with a dull knife, over and over. Other times, my body would break out in a cold sweat from waves of nausea. Even when I wasn’t in pain, my stomach would make noises, prompting people to ask what was wrong. I usually just said that I was hungry, even if I wasn’t. 

When I turned 17, I started experiencing panic attacks in school and was diagnosed with anxiety. I started going to therapy, but it wasn’t helping much, so my therapist recommended that I see a gastroenterologist to check out why I was having so many stomach aches. 

“You need to get a colonoscopy,” the doctor said, to which I replied, “I don’t have time.” 

Then the doctor said, “I don’t want to freak you out, but...,” which is possibly the least comforting thing a medical professional can say. She continued, “In the worst case scenario, you might have colon cancer.” 

I panicked. We scheduled a date for the colonoscopy later that month. As I drove myself back to school, I felt my stomach tighten, and I started to cry. Having bad stomach aches everyday was one thing, but cancer? That was something I was entirely unprepared to hear. 

Most people have their first colonoscopy around the age of 50, so I felt strange preparing for one in high school. In the days leading up to the procedure, I fasted and took laxatives. 

When the results from my colonoscopy came back, I was expecting the worst. The doctor told me that I had lymphocytic colitis, a chronic inflammatory gut disease, which was treatable but not curable. She prescribed budesonide, which many patients with Crohn’s disease take to suppress their immune system. The medicine would ensure that my body would not attack itself and hopefully reduce the inflammation.

The doctor also gave me a list of foods that I couldn’t eat for the next four months. I was horrified. I couldn’t have anything acidic, like coffee, onions or tomatoes and no hearty vegetables like beans, broccoli or cabbage. I should avoid raw fruits and vegetables, limit my fiber intake, cut out dairy and stay away from sugars and carbs. 

So for the next four months, I took my medication every day and ate a plain diet. It was pretty miserable. But my stomach aches went away, and so did my panic attacks. Because I followed the doctor’s instructions, I slowly was able to add foods back into my diet that I actually enjoyed eating. It’s been four years since I was officially diagnosed with colitis and anxiety, but it wasn’t until last month when I was scrolling through my Facebook feed that I realized there could be a direct connection between my stomach problems and my mental health issues. I came across an article that discussed several of the nerve pathways connecting the brain and the gut, and suddenly, a lot of my health problems made sense.

I spoke with Dr. Jay Pasricha, the director of the Hopkins Center for Neurogastroenterology, about the brain-gut connection. His research focuses on the enteric nervous system, which is located in the gastrointestinal tract and contains more than 100 million nerve cells. Since the brain and the gut have the same neurotransmitters, people with gut diseases, especially irritable bowel syndrome, often experience anxiety and depression at higher rates. 

“If you look at prevalence rates of anxiety and depression with irritable bowel syndrome, it’s about 50 to 60 percent or higher, even with colitis and inflammatory bowel disease,” he said. 

Pasricha explained that for many people, anxiety can manifest as a butterflies in the stomach feeling or as a need to go to the bathroom when they’re nervous. But symptoms of anxiety in the form of gut problems are not necessarily the product of mental health issues. Sometimes, mental health problems can arise from gut diseases.

“If you talk to most gastroenterologists, they think of this as a top-down problem: You know, you’re anxious or stressed and that gives rise to bowel symptoms,” he said. “The bottom line is it’s not all in your head. What’s happening in your head can actually start in your gut and vice versa.”

I wanted to better understand how I could use science to improve my own health so I contacted Calliope Holingue, a Ph.D candidate at the Bloomberg School of Public Health. She teaches the SOUL course Mental Health and the Gut (it’s also offered over Intersession) and researches the intersection between physical and mental health. 

“One of the reasons I got into the field is that I also had both of those issues. It motivated me to understand that connection better,” she said. 

Holingue explained that scientists have been trying to learn more about how the gut and brain influence each other since there is an obvious connection. 

“We know that having a mental health issue creates stress in the body and leads to poorer physical health. For example, people with depression are less likely to have good hygiene, a healthy diet and exercise,” she said. “When people have more physical issues, like pain, they tend to develop more mental health issues.”

Holingue also told me that having a healthy diet is one of the best ways to help one’s mental and physical health.

“The diet is arguably the factor that affects our gut health the most, and it’s the one we have the most influence over. A well-balanced diet with lots of different fruits and vegetables — those things will help us have a more diverse gut microbiota ecosystem,” she said. “It becomes a real challenge to find a diet that doesn’t exacerbate symptoms but also doesn’t create this unhealthy gut microbiome that is lacking in diversity.”

Understanding my own body has helped me immensely over the last month. There is no cure for colitis. There is also no cure for anxiety. They will be with me, to a greater or lesser degree, for the rest of my life. But, thanks to discoveries in science and medicine, perhaps people living with chronic gut diseases or mental illness can arm themselves with better tools so that they can live fuller lives. 

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