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Inflammatory Bowel Diseases (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), are characterized by chronic intestinal inflammation and a complex interplay of environmental factors, including diet and stress which can influence disease onset and progression. In this post, I will address bidirectional relationship between disease activity and mental health, the influence of stress, and the impact of stress responsiveness on ‘flare-ups’ of ulcerative colitis, and its connection to my own journey.

“Chronic engagement of the sympathetic nervous system can also increase intestinal permeability, a situation simplistically called a leaky gut in the lay press.”

The sympathetic nervous system is one of the branches of the autonomic nervous system. It activates the body’s “fight or flight” response during life threatening situation, but is engaged in more subtle ways in response to the wear and tear of our modern lives, as well as during physical stresses such as chronically recurring gut inflammation. In the blood, chronic stress can cause an inflammatory subtype of enteric glia, specialized cells in the gut that support and protect the nerves controlling gut functions. These glia recruit inflammatory monocytes (a subtype of immune cells) to the intestine via the colony stimulating factor 1, leading to inflammation. Chronic engagement of the sympathetic nervous system can also increase intestinal permeability, a situation simplistically called “leaky gut” in the lay press. This increase in permeability also leads to activation of the gut-based immune system when immune cells come in close contact with membrane components of gut microbes, triggering a cascade of inflammatory mediators that lead to inflammation in the gut and beyond. In other words, the chronic engagement of both arms of the stress system, the sympathetic nervous system and the glucocorticoid system, results in increased exposure of the gut’s immune and nervous system which favor an inflamed gut.

“…Bernstein’s research shows that childhood socioeconomic status is able to influence host resistance to infectious illness in adulthood, highlighting the long-term effect of early-life stressors on health outcomes.”

Research by Charles Bernstein’s research group at the University of Winnipeg has highlighted the profound relationship between high perceived stress and subsequent symptomatic flare-ups in IBD patients. Statistical analyses has indicated that only high-perceived stress was associated with an increased risk of flare. In other words, their study suggested that it is not the objective stress level encountered by the patient, but the subjective perception of stressful life events. His research emphasized the importance of considering stress management approaches for IBD patients, suggesting that timely stress reduction interventions might be as critical as medication currently used to treat active symptoms. Additionally, Bernstein’s research shows that childhood socioeconomic status is able to influence host resistance to infectious illness in adulthood, highlighting the long-term effect of early-life stressors on health outcomes. This effect was independent of adult socioeconomic status and is consistent with animal research revealing that experiences early in life impact stress responsiveness later in life.

“…higher stress resilience and lower stress responsiveness is associated with fewer IBD flares.”

Laurie Keefer’s research group recently published a report demonstrating that high resilience in IBD patients was independently associated with lower disease activity and better quality of life in patients with IBD, and fewer IBD surgeries in patients with Crohn’s disease. The authors concluded that resilience may be a modifiable factor which can be used to stratify patients with IBD into those with poorer outcomes. Even though not tested in their study, their findings seem to support the concept that higher stress resilience and lower stress responsiveness is associated with fewer IBD flare ups.

Beyond psychological vulnerabilities, stress perception significantly influences IBD progression and severity. For instance, a recent study of ulcerative colitis patients performed by investigators in the Division of Digestive Diseases at UCLA found a 3.6-fold increase in odds of clinical flares in patients with high perceived stress and associated increased stress perception.

“It was only when I started changing my perspective towards stress and began practicing mindfulness that I saw a difference.”

On a personal note, as someone who has been living with UC firsthand, I can attest to the profound impact of psychological stress on my symptoms. College and life pressures often exacerbated my condition. It was only when I started changing my perspective towards stress and began practicing mindfulness that I saw a difference. Connecting with others who had IBD, both online and in person, provided me with a sense of community and hope. It helped me navigate the challenges and uncertainties of living with UC. One notable and trusted resource is the Crohn’s and Colitis Foundation, which provides information on one’s condition, the importance of diet and nutrition, events to meet others with IBD, and much more.