Anxiety-Gut connection: why one affects the other

Have you ever felt nauseous, desperately trying to push down the contents of last nights dinner before giving the bad news to your boss? Or the churning inside your stomach when something you have been preparing for a long time falls apart? You were probably experiencing anxiety.

Anxiety, though classified as a mental disorder, is often associated with physically manifesting symptoms. One of the most common symptoms are reactions from your gut. Hence the adage, ‘butterflies in the stomach’. Sometimes the butterflies are only the tiny Orange Ringlets, only gently floating about; but sometimes, they are Giant Swallowtails stirring up an explosive hurricane.

What is anxiety?

Defined by the American Psychological Association, ‘anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes’¹– such as the nauseating feeling in your gut.

Is there a relationship?

The Anxiety and Depression Association of America makes a pointed claim that anxiety disorders can worsen the symptoms of digestive disorders³. Several studies have also observed that anxiety disorders and digestive disorders were commonly experienced together^4,6.

Emotions and the body

In Chinese medicine theory, the emotional wellbeing and physical wellbeing share a strong inter-relationship. Emotional health can influence the physical health and vice versa. One of the ways in which emotion can affect the wellbeing of the body is by the 7 emotions. An excess of these emotions can negatively influence the health of the body.

Chinese medicine theory also ascribes specific emotions to certain organ functions:

• Grief is associated with the Lung function
• Joy is associated with the Heart function
• Anger is associated with the Liver function
• Fear is associated with the Kidney function
• Over-thinking and worry is associated with the Spleen function

For example, an excess of worry can negatively influence the healthy workings of the Spleen, which is to promote digestion and produce the qi and blood that is necessary to nourish the body. This can manifest as poor digestion, bloating, lack of appetite and fatigue.

Following the definition by the APA¹, worry is the characteristic emotion in anxiety. Hence, it is of no surprise to an acupuncturist that someone who is experiencing anxiety should also experience some digestive issues. Moreover, anxiety disorders are complex and can often involve stress and irritation, which falls under the Liver function and/or fear and fright, which falls under the Kidney function.

‘Shen-Gut’ Connection

The ‘shen’ is an encompassing concept which embodies the mind. It includes both the cognitive and emotional aspects and governs both our thoughts and feelings. In this regard, the disease of the 7 emotions also falls under the disease of the ‘shen’.

In Chinese medicine, there is a special connection between the ‘shen’ and the digestive system:

1.      Connection by organ function

Firstly, the ‘shen’ is housed in the heart and anchored by the blood and energised by the qi. When the ‘shen’ is not sufficiently nourished by the blood and the qi, it can result in emotional disorders such as anxiety. In Chinese medicine theory, the Spleen function is responsible for the digestive system where the qi and blood are produced. Hence, the disease of the digestive system is linked to the disease of the ‘shen’.

Curiously, this finding is replicated in modern research where people with disorders of the digestive system are more likely to have anxiety than people without digestive disorders^4,6.

2.      Connection by channel

Secondly, in Chinese medicine theory, the Heart channel is paired with the Small Intestine channel in a yin-yang relationship and shares the ‘fire’ phase. The small intestine channel is therefore directly linked to the heart channel at the pinky and feeds into the small intestine organ. The small intestine is of course, the organ in our body where most of the absorption of nutrients occurs.

Acupuncture for anxiety and depression

There is emerging evidence demonstrating that acupuncture can be beneficial for people with anxiety compared to no treatment^3,7,9. Moreover, acupuncture has been associated with fewer side effects than conventional therapy².

Currently, there is increasing interest in using acupuncture for managing the increase in the prevalence of anxiety due to the COVID pandemic⁵ and the benefits of acupuncture in combination with conventional management¹⁰.

Acupuncture has also demonstrated to be beneficial in managing variety of digestive conditions such as the Crohn’s disease, chronic constipation and Irritable Bowel Syndrome^8,12,13. The mechanism for which has been suggested to involve stimulating neural reflexes in the digestive system¹¹.

What can you do?

Acupuncture is a safe and effective approach to managing your anxiety and digestive issues. Daniel is an acupuncturist at Health Space Kingsford with a keen interest in anxiety disorders and associated digestive conditions.

Reference List

1. American psychological association. (2021). Retrieved from: https://www.apa.org/topics/anxiety
2. Amorim, D., Amado, J., Brito, I., Fiuza, S. M., Amorim, N., Costeira, C., & Machado, J. (2018). Acupuncture and electroacupuncture for anxiety disorders: a systematic review of the clinical research. Complementary therapies in clinical practice, 31, 31-37.
3. Anxiety and depression association of America. (2021). Retrieved from: https://adaa.org/understanding-anxiety/related-illnesses/irritable-bowel-syndrome-ibs#:~:text=People%20feel%20the%20effects%20of,feel%20sick%20to%20your%20stomach.
4. Hartono, J. L., Mahadeva, S., & GOH, K. L. (2012). Anxiety and depression in various functional gastrointestinal disorders: do differences exist?. Journal of digestive diseases, 13(5), 252-257.
5. Jia, H., Han, Z., Zhang, K., Tang, Q., Sun, K., Huang, H., & Qi, F. (2020). Acupuncture and related interventions for anxiety in coronavirus disease 2019: A protocol for systematic review and meta-analysis. Medicine, 99(30).
6. Lee, C., Doo, E., Choi, J. M., Jang, S. H., Ryu, H. S., Lee, J. Y., … & Kim, Y. S. (2017). The increased level of depression and anxiety in irritable bowel syndrome patients compared with healthy controls: systematic review and meta-analysis. Journal of neurogastroenterology and motility, 23(3), 349.
7. Li, M., Xing, X., Yao, L., Li, X., He, W., Wang, M., … & Yang, K. (2019). Acupuncture for treatment of anxiety, an overview of systematic reviews. Complementary therapies in medicine, 43, 247-252.
8. Liu, Z., Yan, S., Wu, J., He, L., Li, N., Dong, G., … & Liu, B. (2016). Acupuncture for chronic severe functional constipation: a randomized trial. Annals of internal medicine, 165(11), 761-769.
9. Sniezek, D. P., & Siddiqui, I. J. (2013). Acupuncture for treating anxiety and depression in women: a clinical systematic review. Medical acupuncture, 25(3), 164-172.
10. Tan, A., Wang, M., Liu, J., Huang, K., Dai, D., Li, L., … & Wang, P. (2020). Efficacy and safety of acupuncture combined with western medicine for anxiety: A systematic review protocol. Medicine, 99(31).
11. Takahashi, T. (2011). Mechanism of acupuncture on neuromodulation in the gut—a review. Neuromodulation: Technology at the Neural Interface, 14(1), 8-12.
12. Joos, S., Brinkhaus, B., Maluche, C., Maupai, N., Kohnen, R., Kraehmer, N., … & Schuppan, D. (2004). Acupuncture and moxibustion in the treatment of active Crohn’s disease: a randomized controlled study. Digestion, 69(3), 131-139.
13. Chao, G. Q., & Zhang, S. (2014). Effectiveness of acupuncture to treat irritable bowel syndrome: a meta-analysis. World Journal of Gastroenterology: WJG, 20(7), 1871.

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