It's no surprise that talking about the food we eat and how our digestive systems process it can be... weird. Even in the era of wellness culture, open discussions of digestive health and conditions like irritable bowel syndrome (IBS) remain taboo.
Despite this, one of every 20 Americans experience IBS, according to the American College of Gastroenterology. But what is IBS? The Mayo Clinic states that irritable bowel syndrome is a disorder affecting the large intestine, whose symptoms include cramping, abdominal pain, bloating, gas, diarrhea, and/or constipation.
While one of the likely causes is certainly food intolerances, there are a plethora of other reasons why one may experience such digestive symptoms. IBS may be a symptom of other chronic illnesses, including fibromyalgia, endometriosis, and inflammatory bowel diseases (IBDs) such as ulcerative colitis and Crohn's disease. However, a link between our nervous system, IBS, and stress has also been identified.
The link between stress, trauma, and IBS
"The vagus nerve is the major nerve that runs down from the brain through the abdomen. Along its route, we have the heart, we have the lungs, we have all of digestion," Erica Harsch, MS, CNS, CLT, a certified nutritionist with Dandelion Nutrition in Maple Leaf, told the SGN. When humans go into fight-or-flight mode, the vagus nerve will tell the body to shut down everything but the heart and lungs.
"So while that was very helpful if a tiger came into your village," Harsch added, "if you're sitting at work and you have a lunch break in an hour, and there's nowhere for you to run, you just feel miserable. Our contemporary times have made it so that our body has to eat that stress."
For members of marginalized groups, the trauma they may face can impact how their own bodies process the food they consume. As for LGBTQ people, 30-60% experience anxiety and depression in their lifetimes, a rate that is 1.5-2.5 times higher than the general population.
Brooke Stepp, MS, CN, LMHC, a licensed mental health counselor and nutritionist with Have Heart Healing and Wellness in Capitol Hill, says that despite seeking treatment for nondigestive concerns, eight or nine out of every ten clients they see experience digestive symptoms.
"What I would say is that when people do come in wanting to work on their relationship to food and body, or they are experiencing an eating disorder, they're having gender feels, or there's an experience of racialized trauma inside of this world... Often the digestive symptoms are coming with those things," Stepp told the SGN.
Stepp has found the book The Physiology of Sexist and Racist Oppression by Shannon Sullivan to be helpful in contextualizing how trauma and the gut interact in both their own life and when working with clients.
"In that book, what the author is naming — and I think is really interesting — is this reality of patriarchy, and in reference to LGBTQ people, we could talk about the reality of homophobia. The gut in the body is the thing that separates us from the outside world. Technically, that is the actual barrier between ourselves and the world," said Stepp. "What [Sullivan] kind of names is that any gut symptoms are really like this inability to digest the world that is happening outside of ourselves. That's the world that is not palatable, the world that is not able to be assimilated because of its relationship to oppression."
The onset of the pandemic has also likely heightened people's awareness of their own digestive pain. A June 2021 study led by UW Medicine found that since the start of the pandemic, 44-48% of participants reported increases in abdominal pain, diarrhea, and constipation, along with increases in stress and anxiety.
Self-care advice when dealing with digestive symptoms
For those experiencing chronic digestive pain, there are several registered dieticians in Seattle who have LGBTQ+ friendly practices. Harsch also that noted nutrition is covered well under preventive care in Washington, though patients should still check their insurance. And the pandemic has made telehealth easier to conduct.
But if people are still reluctant or unable to seek expertise for their digestive symptoms, both Harsch and Stepp shared some advice to consider.
Before focusing on nutrition, Harsch recommends patients work on four things:
Stepp also recommends managing anxiety using practices at whatever capacity the individual can do, including relaxing activities like going for a walk, as well as being open about stress and paying attention to when symptoms occur in relation to their life. It can also be helpful to create a space to be mentally present when eating. This can include setting an intention to put your phone away for five minutes of your meal or eat with a friend over Zoom.
"Paying attention to the state of the nervous system before, during, and after meals can really make all the difference, because we really want to give a safe, secure place for our food to be digested," said Stepp. "A nervous system that is really frozen, or a nervous system that is really jacked up, just won't be able to assimilate those nutrients."
For those experiencing a flare-up, it can be helpful to remind oneself that the pain will eventually pass.
"I know that sometimes for me, and when I've had the flares in the past, I've been like, Oh, my God, not again, this is never going to end," said Stepp. "Let yourself notice that those are thoughts, and there's a reality that's separate from those thoughts and those worries. There's also the capacity to take a deep breath, feel your feet on the ground, [and] know that this moment is happening, the next might be different than this moment."
"I think a lot of folks who have chronic illness do a lot of blaming," said Stepp. "There can be a lot of shame and [thinking] I did this to myself, and we really want to take the moralism out of digestive problems and know your symptoms really make sense inside of this world and inside of these conditions."