Crohn’s disease is a form of inflammatory bowel disease that causes pain, bloating, fatigue, and severe diarrhea. Unlike colitis which only affects the colon, Crohn’s disease affects different areas in different people.
We don’t yet know the cause of Crohn’s disease. People with Crohn’s often present with alterations in their gut microbiome, and this likely plays some role. The microbiome regulates our physiology in many ways that predispose us to gut inflammation.
We also know that stress causes people to experience Crohn’s flares. But how can stress cause a Crohn’s flare up? There are multiple pathways via which stress causes issues in the gut. If we take a peep at the pathways involved, they’re pretty similar to the above:
A new paper in mice gives us a clue as to how stress induces a flare up of Crohn’s disease. Consequently, it makes clear that managing stress should be the #1 tool in the toolkit of people who suffer with Crohn’s disease.
How can stress cause a Crohn’s flare up: mouse edition
Unfortunately, it’s extraordinarily difficult to follow the progression of a Crohn’s flare up in humans. Therefore, in situations like this, we take what we see in human outcome studies and use animal models to find out why something happens.
In this study, they exposed mice to repeated psychological stress. As a result, there were major shifts over time in the microbiome. Changes include a drop in beneficial microbes and expansion of adherent-invasive E. coli(AIEC). Increased levels of AIEC may cause Crohn’s disease.
Failure of the mucosal defense system caused the changes. Elevated levels of glucocorticoids(cortisol) depleted immune cells that produce IL-22, which maintains a healthy gut environment. As a result, this created conditions that promote AIEC expansion in the gut.
Interestingly, stress promoted inflammation and “leaky gut” in all mice. However, in those infected with AIEC, the inflammation and permeability were greater.
It’s important to point out that all mice had some level of AIEC in their gut, and inflammation due to repeated stress promotes their expansion. In other words, chronic stress may predispose to expansion of AIEC, which in turn leads to Crohn’s disease.
What does this tell us about stress and the gut?
Most functional GI disorders are exacerbated by stress. And there is data in humans that stress, specifically relationship stress, promotes inflammation and intestinal permeability.
Clearly, managing stress is important for maintaining a healthy gut. But the stakes are higher for those with FGIDs. Essentially, they have a hair trigger compared to those without one.
Regardless, managing stress is essential to a healthy gut. Unfortunately, many take this to mean they should avoid stress at all costs. This couldn’t be further from the truth.
There will always be stress, and it’s important to make sure you can handle it when it comes. Two critical factors to managing stress include building resilience to it and eliminating unnecessary stress.
Building resilience to stress is almost entirely accomplished through lifestyle. This includes things like optimizing circadian rhythms, prioritizing sleep, exercise, eating a healthy diet, and so on. You can check out a blog where we cover the ins and outs of this here.
Avoiding unnecessary stress involves controlling exposure to stressors that you have control over. Things like paying your bills on time, giving yourself adequate time to get to work, and maintaining healthy relationships.
Ultimately, prolonged exposure to unmitigated stress will wreck your gut. Fortunately, many are beginning to see this and take control. Yes, things like probiotics and prebiotics may be useful for certain FGIDs.
But if you create an environment that creates a competitive advantage for bad actors in the microbiome, those tools are useless.