Anxiety-diarrhoea: what causes it and how to cure it

If you’ve ever received distressing news and needed to rush to the bathroom...

Abridged from an article in Epoch Times,

Republished from DrRuscio.com

Anxiety-diarrhoea is a delicate topic

Picture: If you’ve ever received distressing news and needed to rush to the bathroom, you know that feeling anxious or nervous can have a direct effect on your digestive system.

Anxiety diarrhea is a delicate topic, but definitely worth addressing…

The gut-brain connection

Several science reviews have found that anxiety often exists alongside irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and celiac disease [9, 10, 11, 12, 13, 14]. But it’s not clear which comes first.

In medical practice, we’ve found that many patients with gut issues develop anxiety, and healing the gut often improves anxiety.

Below we’ll walk you through how to heal your gut to lessen your anxiety.

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Three gut-related steps to beat anxiety-diarrhoea

While there‘s likely no “perfect” gut health prescription to keep anxiety diarrhea under control, the following three self-care steps will improve the robustness of your gut in general. In turn, this could improve your chances of tamping down any generalised anxiety disorders.

Step 1: Remove the foods that don’t suit you

Removing triggers such as gluten from your diet quite often allows your gut to heal and your anxiety symptoms to improve.

For example, one 2016 pilot study explored the effects of a six-week gluten-free diet (GFD) in 41 subjects with IBS-D (irritable bowel syndrome with a major diarrhea component). Half of these subjects tested positive for a gene that increases the risk of gluten allergy, while the other half were negative for the same gene. The results showed that [20]:

• Cutting out gluten not only significantly reduced bowel symptoms like diarrhoea but also anxiety and depression in both groups.

• Those who tested positive for the gluten allergy gene had a greater improvement in depression, vitality, emotions, and fatigue.

Getting started on FODMAPs

Researchers studied if a low-FODMAP diet would improve anxiety, depression, and quality of life in patients with IBS and diarrhoea. A total of 92 patients were randomly assigned to consume either a low-FODMAP diet or a diet based on standard IBS recommendations. After four weeks, the results showed [21]:

• The low-FODMAP diet significantly improved anxiety, stool consistency, and urgency.

• Other benefits seen in the low-FODMAP group included significant improvements in abdominal pain, bloating, quality of life, activity impairment, body image, and depression compared to the standard IBS diet.

A low-FODMAP diet doesn’t have to be the first diet you jump into. For dealing with anxiety and gut issues, many of my patients find an ancestral-focused paleo-style diet helpful.

Paleo-style diet

A paleo-style diet that removes highly processed foods and foods that frequently cause intolerance or sensitivity (like wheat and gluten) may be adequate to improve gut health and reduce anxiety.

Low-FODMAP diet

A low-FODMAP diet is probably a better fit for symptoms that don’t respond to a Paleo diet, including more severe anxiety, diarrhoea, bloating, and digestive upset. The key to this diet is finding your own specific tolerance to each of the carbohydrates and prebiotics in the FODMAP list that may be feeding an overgrowth of less than healthy bacteria.

Different people will have different tolerances to FODMAPs, and over time, this will almost certainly change. This means as your gut heals you can introduce more carbohydrates and prebiotics, while still keeping digestive tract symptoms, like anxiety-diarrhoea, at bay.

Probiotics

Due to their balancing effect on the gut bacteria, probiotics (yoghurt bacteria) may be another strategy to help deal with anxiety and diarrhoea.

Probiotics often stand up quite well for the alleviation of anxiety symptoms, and this is especially the case in clinically anxious people [24, 25]. However, dietary interventions are even more effective, so they should be the first choice for anxiety management [26].

One possible reason for the beneficial effect of probiotics could be that they help heal a leaky gut [27]. Increased intestinal permeability allows bacterial toxins to leak into the bloodstream and contributes to anxiety [28].

In one preliminary study, a total of 83 patients with anxiety and depression (only eight of whom also had IBS) were given a multi-strain Lacto/Bifido probiotic for two months. The results showed significant improvements in depression and anxiety, quality of life, and GI symptoms, including diarrhoea [22].

A 2021 systematic review identified five studies that showed probiotics improved diarrhea and one study that showed probiotics improved anxiety [23].

Which Probiotics Work Best?

In the clinic, we’ve found a Lactobacillus/Bifidobacterium blend, combined with Saccharomyces boulardii and soil-based probiotics, is an effective and well-tolerated combination for healing the gut and reducing anxiety [29, 30, 31].

This doesn’t mean another type of probiotic won’t be helpful for anxiety diarrhoea, though, and you probably don’t have to search for a super-specific type of bacteria for anxiety. In fact, from my clinical experience, a blend of species is probably best to cover all bases.

Herbal antimicrobials such as Berberine

Herbal antimicrobials benefits. (Dr. Ruscio)

If dietary changes and probiotics don’t resolve symptoms significantly, herbal antimicrobials such as berberine are sometimes recommended as part of a gut-healing program. For people with anxiety-diarrhoea, they may be particularly beneficial.

One 2015 randomised controlled trial randomly assigned IBS patients with diarrhoea as a main symptom to receive 400 milligrams a day of berberine hydrochloride or placebo for eight weeks. The results showed that berberine supplementation significantly reduced diarrhoea frequency and anxiety after eight weeks of treatment, compared to placebo [32].

Abdominal pain, urgency, depression, and quality of life also significantly improved in the berberine group compared to placebo. These results help solidify the gut-brain connection and suggest that an underlying gut bacteria imbalance may be at play in those with anxiety.

Internet search results for Berberine

Berberine is recognised as a Chines traditional medicine and has proven health benefits besides those for anxiety-diarrhoea.

Berberine search on DuckDuckGo

The role of berberine in Covid-19: potential adjunct therapy

Alternative approaches for anxiety diarrhea

(Cliff Booth/Pexels)

Alternative or complementary therapies can have benefits for anxiety diarrhea, for example:

• Meditation was beneficial in a small trial involving 16 IBS patients who practiced relaxation response meditation (RRM) for six weeks. The results showed that mediation significantly improved IBS symptoms (diarrhea, flatulence, belching, bloating) compared to the control group, while 39 percent of subjects reported improved anxiety [33].

• Yoga plus deep-breathing exercises were more effective than loperamide (Imodium) in IBS patients after two months of twice-daily sessions. Both groups saw significant improvements in IBS-D symptoms and anxiety, but it was the yoga group saw the greater improvement in bowel symptoms [34].

• Traditional Chinese medicine (TCM) (specifically, moxibustion, which involves burning processed mugwort herb at specific acupuncture points on the body) improved IBS-D symptoms more effectively than a sham version. After six weeks, the results showed that the TCM group had significantly greater improvement in diarrhea frequency and bowel urgency [35].

Many mind-body techniques, including the ones mentioned above, are safe, easy to do at home, come at little or no cost, and can be implemented alongside dietary changes, making them a great choice for resolving anxiety-related symptoms.

Cognitive Behavioral Therapy (CBT) for Anxiety

CBT can help anxiety, and it can also be useful in IBS, so it’s another treatment worth considering for anxiety diarrhea [36].

One study found CBT combined with drug therapy significantly improved IBS-D symptoms and quality of life compared with drug therapy alone. However, the symptoms appeared to return after CBT was discontinued [37].

Another study found that CBT plus exercise significantly improved IBS-D symptoms compared to a control group after six, 12, and 24 weeks. Additionally, the CBT appeared to significantly improve the thinking patterns and coping styles of people with diarrhea symptoms [38].

Healthy living’s comment on CBT

In my experience, the CBT therapist seems to me like a shepherd observing and managing a flock of sheep. In this analogy, the flock is my flock of thoughts, feelings, and emotions, which the therapist observes and manages by the use of his CBT tools and techniques.

Having experienced how effective the CBT’s “Shepherd of the thoughts feelings and emotions” approach can be, I have made an effort to learn from the therapist (and my own reading and experiences), to develop the CBT skills and apply them to myself. (Note that my reading is broad and includes but is not limited to a study of the bible, which teaches the wisdom of the ancients and so balances out the passing fads of today’s sometimes misguided world).

I now see myself as the shepherd of my own thoughts feelings and emotions. A good shepherd continually checks his stock and thinks about how to manage them better, to stay healthy and productive. A good shepherd is constantly asking himself how he can be better at being a good shepherd.

Can you see the value of better managing your thoughts and feelings? - Try the good shepherd approach. I think you will find it works.

Can Conventional Antidepressants Help?

Not a great deal.

One systematic review and meta-analysis suggested that traditional antidepressants, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-noradrenaline reuptake inhibitors (SNRIs), help quell gut symptoms (especially diarrhea), as well as ease depression and anxiety more generally [39].

Antidepressants can have their side effects, however, and these include significant disruption of the gut microflora [31]. For this reason, I wouldn’t recommend traditional antidepressants as a first-line choice for anxiety diarrhea.

If you’re already on these medications or need them temporarily to get through a bad time, don’t beat yourself up. Taking probiotics and improving your diet will help to mitigate the downsides, and simply getting out for a walk in the sunlight is likely a greater help.

Say goodbye to anxiety diarrhoea

Diarrhoea is a distressing reality for many people with anxiety. To break through the cycle of anxiety, upset stomach, and more anxiety, you can bolster your gut health, helping to normalise the gut-brain connection.

Going gluten-free or low processed, (including a Paleo or low-FODMAP diet) combined with probiotics are all effective ways to decrease diarrhoea anxiety, but if these don’t work effectively enough, herbal antimicrobials, CBT, meditation, or other relaxing therapies like yoga may also help.

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