Digestive Issues? Here’s What You Need to Know About Stress + The Enteric Nervous System


Bloating, reflux, diarrhea, nausea, constipation, excessive gas — these are just some of the many digestive issues I help my patients with. Typically, we start by making dietary changes, such as removing dairy or gluten, or trying an elimination diet to pinpoint any food sensitivities. Oftentimes, this can help heal the gut and get digestion back on track. 

Other times, however, no number of dietary adjustments seem to push the needle quite far enough. In this case, the next place I turn my attention to one place and one place only — stress. 


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The Stress-Digestion Connection

When we talk about digestive issues, it’s easy to put all the focus on food. Especially in the health and wellness world, there’s no shortage of people telling you what to eat, what not to eat, and why food is at the center of wellness. And while I do believe wholeheartedly that food can act as medicine or the trigger for disease, it’s not where the conversation ends! If you’ve been eating healthy but you’re still dealing with digestive issues, there’s a great chance your stress levels are playing a part. The research doesn’t lie: 

  • Stress is known to increase intestinal permeability, leading to conditions like leaky gut.  
  • Stress increases your susceptibility to chronic inflammation in the colon and GI tract. (1
  • Stress is associated with gastrointestinal disease, including functional bowel disorders, inflammatory bowel disease, peptic ulcer disease and gastroesophageal reflux disease. 
  • Stress is a known trigger for flare-ups in inflammatory bowel disease like Crohn’s disease and ulcerative colitis. (2

Being under chronic, sustained stress can sabotage your digestion so practically no matter what you eat, you’re going to have trouble digesting in a way that’s comfortable and helps you absorb and utilize the nutrients in the food you eat. Why? Because of the almost endless connections between stress and the gut, starting with the enteric nervous system. 

READ MORE: The 14 Best Herbs For Intestinal Inflammation

Meet the Enteric Nervous System

So what explains this intricate connection? One big piece of the puzzle is the enteric nervous system (ENS), which is the part of the nervous system that actually lives within the walls of the gastrointestinal tract. Yes, you heard that correctly! The over 200 to 600 million neurons of the ENS are embedded in the mucosal lining and muscles that make up the gut and are found from the very start of the digestive tract (the esophagus) to the very end (the anus). (3) The ENS works directly with the central nervous system to modulate digestion — mainly processes like initiating swallowing and the release of digestive enzymes that help you absorb your food — but it’s also involved in other bodily processes, including the stress response. The ENS communicates directly with the central nervous system and the two systems send messages back and forth. 

This connection is so intricate that the gut is often referred to as the “second brain.” And if you’ve ever had a “gut feeling that something was wrong,” felt “butterflies in your stomach,” or found yourself running to the bathroom before a big test or interview, you’ve already seen this connection in action. We’re learning more and more about how digestion and stress are all related every single day. And one of the most interesting areas of study has to do with a single but large and powerful nerve called the vagus nerve. 

The Vagus Nerve

You might be wondering how the gut and brain send messages to each other all day long. Well, the answer is the vagus nerve. The vagus nerve is a long, winding nerve that travels from the base of the brain into the abdomen and is the main connection between the gut and brain. Research has shown that lower activity of the vagus nerve (which is measured as high or low “vagal tone”) can be connected to chronic inflammation, immune system issues, digestive issues, and poor emotional regulation and stress resilience. 

For years it was thought that depression and anxiety could “trigger” digestive issues. But now we’re learning that issues with the ENS may also trigger emotional shifts often experienced by people who have IBS or other digestive issues like diarrhea, constipation, and chronic bloating. In other words, the brain can trigger digestive issues and digestive issues can trigger changes to mood. This two way connection also helps explain why antidepressants can sometimes help improve GI symptoms and diseases. (4

How to Heal Digestion by Reducing Stress

It’s pretty obvious by now that the connection to the gut and brain is one we should all know about. And if you’re dealing with digestive issues and haven’t had luck with other lifestyle or dietary changes, it’s time to turn your attention to some tips and tricks that can help you reduce stress. It’s a good idea to work with a functional medicine expert on your individual health issues, but here are a few places you can start. 

1. Strengthen the vagus nerve

If you have a low vagal tone, that doesn’t mean there’s nothing you can do about it! In fact, I wrote an entire article about how to strengthen your vagus nerve, which includes things like breathwork and taking cold showers. 

2. Exercise 

If there’s one thing I recommend for stress, it’s moving your body daily. Even if it’s just for 10 minutes, exercise can help you release more feel-good chemicals in the brain and improve stress levels AND digestion. Studies have shown that using exercise as an intervention can improve symptoms of IBS. (5

3. Try therapy 

You might be reading this article and think that your daily stress levels aren’t all that bad. But here’s the truth: the mind often forgets things that the body remembers. This is especially true when it comes to past trauma, hurt, or grief. Many of us spend our days distracted by daily tasks, feeling pretty good and moving through life without pausing long enough to feel our feelings or really connect with our deeper emotions. Seeing a qualified therapist can help you unpack any feelings or experiences that are below the surface so that you can process them and feel more at ease. Seeing a therapist is a good idea for anyone, but I especially recommend it if you have stubborn digestive problems. Studies have shown that cognitive behavioral therapy can be even MORE effective than traditional interventions for IBS symptoms. (6

4. Do daily breathwork 

As a functional medicine practitioner, my job is all about improving mental and physical health and helping my patients understand the mind-body connection. And breathwork is the perfect tool for improving the mind-gut connection. If you want to try breathwork, you can read more about it here. I recommend starting with diaphragmatic breathing, which can help activate the gut-nervous system connection. 

5. Try calming supplements and herbs 

There’s a long list of supplements and herbs that can help balance the stress response and that may help improve the mind-gut connection. This includes nutrients like magnesium, which is known as nature’s “relaxation” mineral, herbs like chamomile and cannabis, and adaptogens like reishi and ashwagandha. The more you can focus on taming the nervous system and staying calm throughout the day, the better your digestion will be. 

While I always take a food first approach to medicine, sometimes turning our attention to our stress levels can really be what leads to healing. When your body feels like it’s under attack, it’s going to resist healing in every way possible and stay in “fight or flight” mode. Luckily, the solutions above can help turn this mind-gut connection into a beneficial one. 

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  1. Facts & Statistics Anxiety and Depression Association of America https://adaa.org/about-adaa/press-room/facts-statistics
  2. Kassed CA, Herkenham M. NF-kappaB p50-deficient mice show reduced anxiety-like behaviors in tests of exploratory drive and anxiety. Behav Brain Res. 2004;154(2):577‐584. doi:10.1016/j.bbr.2004.03.026
  3. Crippa JA, Derenusson GN, Ferrari TB, et al. Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. J Psychopharmacol. 2011;25(1):121‐130. doi:10.1177/0269881110379283
  4. Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology. 2011;36(6):1219‐1226. doi:10.1038/npp.2011.6
  5. Hill MN, Patel S. Translational evidence for the involvement of the endocannabinoid system in stress-related psychiatric illnesses. Biol Mood Anxiety Disord. 2013;3(1):19. Published 2013 Oct 22. doi:10.1186/2045-5380-3-19

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Dr. Will Cole, DNM, IFMCP, DC is a leading functional medicine expert who consults people around the globe, starting one of the first functional medicine telehealth centers in the world. Named one of the top 50 functional and integrative doctors in the nation, Dr. Will Cole provides a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is the host of the popular The Art Of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian, The Inflammation Spectrum and the brand new book Gut Feelings: Healing the Shame-Fueled Relationship Between What You Eat and How You Feel.

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Gut Feelings

Healing The Shame-Fueled Relationship
Between What You Eat And How You Feel