Post-traumatic Stress and Gut Health
There is growing awareness about the impact of trauma on our lives and our health. Is it possible to protect our gut and maintain good digestive function when we have had trauma or even currently suffer from Post-traumatic Stress (PTS)? Yes, it is possible to make changes in our daily life that protect us from the impact of trauma, and even support recovery from PTS. There are powerful tools we can use in our minds and for our bodies to help digestive function even in the face of stress related to trauma.
Please note that I prefer to leave the “D” off of PTSD given that the word “disorder” for many people has stigma attached to it. The development of PTS symptoms following a traumatic stressor are not a choice a person makes, or a sign of any weakness. PTS symptoms are a biologically wired response to trauma in certain situations. Even dogs and other animals get PTS symptoms in response to trauma.
“The repeated activation of this survival mechanism of “fight-flight” impairs ones health in many ways”.
First, a few basic facts about how traumatic events impact the body. Digestion is best when our body is in a state of calm and ease. If we are exposed to a trauma reminder or memory, our body may switch into a fight-flight response which causes the release of stress chemicals that are needed if there is a life-threatening emergency. But this reaction is not helpful when it’s a false alarm coming from trauma history. After the trigger the body is no longer in “rest and digest” mode. The repeated activation of this survival mechanism of “fight-flight” impairs ones health in many ways. The problems that occur with these fight-flight reactions include impaired digestion, more inflammation that can worsen digestive disease symptoms and mental health issues like chronic anxiety, sleep difficulties, concentration problems and depression. For more details on the stress response please see the link here.
How do you know if a past traumatic event has led to PTS? The official term, PTSD, has very specific diagnostic criteria set up by the American Psychiatric Association in the DSM-5 manual. Evaluations can be performed by qualified mental health providers, like psychiatrists and psychologists, to evaluate symptoms, make a diagnosis and offer treatment recommendations. How many people over their lifetime may have a diagnosis of PTS at some point? It’s about 6.8% for lifetime prevalence, and in the past year about 3.6% overall, or by gender 5.2% for females and 1.8% for males according to the National Comorbidity Survey.
“To have a PTSD diagnosis one must be exposed to “actual or threatened death, serious injury, or sexual violence”
In brief, to have a PTSD diagnosis one must be exposed to “actual or threatened death, serious injury, or sexual violence,” in one of several ways including: directly experiencing it, as a witness, learning about a trauma event of a family member or close friend, or repeated exposures to traumatic events, such as first responders or medical personnel. If after a month a person is still having a certain number of symptoms in the following categories they may meet criteria for PTSD or have another trauma or stressor related disorder that could be treated. A brief overview of these categories of PTSD symptoms include:
- Reexperiencing (memories, nightmares, flashbacks, physical or emotional reactions to reminders of the trauma).
- Avoidance of reminders of the trauma both external (people, places, situations) or internal (thoughts, feelings).
- Negative changes in thoughts and mood related to the trauma such as negative emotions, loss of interest, feeling detachment from others, inability to experience positive emotions, inability to remember parts of the trauma or negative beliefs or expectations of oneself, others, or the world.
- Changes in arousal and reactivity such as: irritability, anger, reckless behavior, high startle response, hyperarousal, hypervigilance, poor concentration, or sleep problems. Please don’t try to diagnose yourself or a loved one with a trauma disorder, and if these symptoms sound familiar seek professional help.
“The more time a person spends in the fight-flight mode with activation of their sympathetic nervous system, the harder it is for the body to perform digestive and repair functions …”
People who have had trauma exposures, and especially those meeting criteria for PTS, have been found to have higher levels of inflammation in the body and higher frequency of some diseases associated with inflammation. This is part of the relationship between PTS and digestive diseases. The more time a person spends in the fight-flight mode with activation of their sympathetic nervous system, the harder it is for the body to perform digestive and repair functions which require the parasympathetic nervous system. Additionally, poor sleep which is common in PTS can lead to more inflammation and worsening digestive function.
Studies have found inflammation may be present prior to the onset of PTSD and this could predispose people to more health complications. For more detailed discussion on the connection between PTS, inflammation and the relationship to other health issues see this helpful article.
There have been a number of studies that looked at the relationship between digestive issues and PTS. The association of PTS with gastrointestinal disorders was examined in a large Danish cohort study across 18 years. Gradus and colleagues found those with PTSD had a 25% risk for a GI disorder which was much higher than in the general population.
“Digestive disease episodes and treatments can lead to PTS in those that didn’t have it previous to the development of digestive disease.”
Digestive disease episodes and treatments can lead to PTS in those that didn’t have it previous to the development of digestive disease. For example, in a study of people with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) patients, those with IBD, especially people with Crohn’s disease, were more likely to relate their experience of PTS to being hospitalized and having surgery for IBD. Authors concluded that an assessment for PTS should be done in all people with IBD so that treatments could be offered.
How common is PTS in those with IBD? Taft and colleagues found that ¼ to 1/3 of patients with IBD reported significant PTS symptoms and, “Patients with higher PTSD symptoms are less likely to be in remission and may utilize more outpatient gastrointestinal services.” Note this is a much higher rate than the general population as noted above in this article at 3.6%.
What about those with IBS? In a meta-analysis of 8 studies, Ng and colleagues found “PTSD is associated with an increased likelihood of IBS.”. One study in veterans with PTSD the found that 25% met the Rome III criteria for IBS.
In a study of people with Crohn’s disease over an 18-month period, authors found that those with a higher score on the PTSD assessment had more exacerbations of CD symptoms and concluded that assessment and treatment of PTS may be indicated in addition to CD treatments.
“There are many effective ways of working with PTS symptoms on your own, and with support from professionals, that can improve mental and physical health.”
There are many effective ways of working with PTS symptoms on your own, and with support from professionals, that can improve mental and physical health. The basics include working with the mind to change ones thoughts away from fear, anxiety, or patterns of reliving the trauma. Learning to catch the fight-flight responses caused by trauma reminders, and that lead to body tension, increased heart rate, panic, sweating or restlessness, can help a person to get out of the stress mode more quickly. Over time practicing catching these automatic responses may help a person learn more about what triggers them, and become able to make changes to reduce the triggers. Body movement is very helpful to reduce stress and relax. This may include yoga, tai chi, swimming or walking to name a few.
Making certain changes to daily routines can also lower stress and improve digestion. It’s helpful to practice mindful eating to shift the body into the parasympathetic nervous system where there is greater secretion of digestive enzymes and improved motility. There are other helpful changes one can make such as, improving sleep, adding exercise to release tension and stress, eating a healthier diet focused on lowering inflammation, or reducing use of caffeine and alcohol which can disrupt sleep and worsen anxiety or depression. Mindfulness practices, meditation or prayer often help people to learn to calm their mind and find ways to soothe themselves during periods of stress or trauma memories. Good social support from people is very helpful in trauma recovery, and this may include being with animals. Spending time in nature can be healing for many people and help to reduce stress.
There are many resources and further information at the National Center for PTSD. Please talk with your healthcare providers if you have concerns that past trauma may be impacting your digestive or mental health.
Kerry Wangen, MD, PhD is a psychiatrist who focuses on the mind-body connections for optimal mental health. She is board certified in psychiatry and has a telehealth practice serving people in California. She has been practicing meditation since her teens.