Mental Health & IBD

IBD affects all areas of our lives and can make day to day life really difficult. There are several coping tools that can help us manage our disease and mental health better. 

The gut-brain axis is what we call the bidirectional bond between the central and the enteric nervous system. Your vagus nerve links the gut and brain and sends signals between both. Because the gut and brain are so interconnected, using techniques to calm the brain improves gut symptoms and vice versa.

Lifestyle Strategies:

• Taking it one day at a time
  • Allow yourself to grieve, but don’t stay there – practice gratitude for what your body can do 
  • Know that people are working hard on research, treatment options, and management of your disease – helps you feel seen 
  • Prepare for the day ahead of time – allowing extra time in the mornings, plan for breaks, plan meals and snacks, set out clothes – anything you can do to reduce stress 
  • Build structure into your day no matter what disease stage you are in and plan plenty of time for your medical care and routine 
  • Plan for plenty of rest and something to look forward to during the day – a hot bath/shower, calling a friend or family member, taking a walk
  • Know your needs and limits – maybe getting ready for the day is helpful for you, maybe wearing loose clothing and not spending extra energy on hair and makeup is best, saying no to a social gathering may be in your best interest, or maybe you do need to 
  • Surrounding yourself with supportive people and loved ones 
  • Find support groups and connect with others 
•   Stress reduction techniques 
  • Diaphragmatic or Deep Breathing
    • You can use this daily upon waking, before meals, between meetings or clients, before bed, and any other times you feel uneasy and stressed 
  • Progressive Muscle Relaxation 
  • Yoga
  • Meditation
  • Journaling 
  • Reframing thought patterns
    • Example: I can never eat beans because I will always bloat and have diarrhea to I know fiber is really helpful for my gut, how about I explore what a small portion of beans feels like for a little while
• Seek professional help 
  • It’s important for all of those with IBD to have access to psychological help, but that isn’t always the case. Being newly diagnosed with IBD can be a great time to seek out help as you navigate emotions and treatment options for your disease. Some evidence-based therapies for IBD include: 
    • Cognitive Behavioral Therapy
      • Working with a therapist to change negative thought patterns and behaviors to improve quality of life 
    • Gut-Directed Hypnotherapy 
      • Patients can learn to feel more in control of their symptoms using gut-directed hypnotherapy, which uses deep relaxation techniques like guided imagery and meditation. This type of therapy has been shown to reduce inflammation in the body and longer remission periods. 
    • Meditation and Mindfulness Based Therapy
      • Psychotherapy that incorporates mindfulness, meditation, and cognitive therapy to create a present-oriented, non-judgemental state. 
      • This type of therapy has been shown to improve depression, anxiety, and quality of life in those with IBD 
    • Medications
      • There are a lot of stigmas around medications for mental health, but when we experience severe depression and anxiety medication can be a lifeline. Seek the help of your dr and/or ask for a referral to a psychologist. 

Dietary Strategies 

• Supporting overall mental health with a diet rich in plants, antioxidants, whole grains, and fatty fish. This would be consistent with our approach here at the Crohn’s and Colitis Dietitians. 
• Eating enough: 
  • Depression is routinely accompanied by sadness and loss of appetite, leading to inadequate intake, poor food quality, and loss of interest in pleasurable activities. An undernourished gut is a stressed gut, which can exacerbate IBD symptoms. 
    • https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC2738337/ 
  • Those with IBD often voluntarily restrict their intake because eating the food tends to trigger unpleasant symptoms and a cycle of fear easily manifests. Some may even meet the criteria for Avoidant Restrictive Food Intake Disorder (ARFID), as diagnosed by the DSM-5. This would be in the case where someone is unable to 
    • https://pubmed.ncbi.nlm.nih.gov/25142784/ 
  • Restrictive eating behaviors can easily lead to malnutrition in IBD due to inadequate intake. Studies have shown that 16-68% of IBD patients are malnourished, with a restrictive eating prevalence rate of 12-21% in GI disorders. Malnourished patients are at higher risk of surgeries, hospitalizations, longer hospital stays, flare, and mortality risk. 
    • https://www.sciencedirect.com/science/article/pii/S1542356521008648 (malnutrition risk)
• Vitamin D
  • Adequate vitamin D status is associated with reduced relapse rates in IBD as well as reduction of depression, improvement in coping with negative emotions, and improvement in quality of life. This provides promising insight for usage of vitamin D to support mental health in IBD. 
    • https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8540769/ 
  • Food sources: fatty fish, certain mushrooms 
• B12
  • There is a proven relationship between B12 and depression, lower levels of B12 in the body is associated with higher risk of developing depression. B12, along with other nutrients like folate and B6 work together in neurochemical pathways. If any of these are suboptimal, reduced neurotransmitter signaling can occur leading to depressive symptoms. This is particularly important in IBD since nutrients like B12 are commonly low. 
    • https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7688056/ 
  • RDA: 9–13 years: 1.8 mcg (males and females), 14+ years: 2.4 mcg (males and females), 2.6 mcg (pregnancy), 2.8 mcg (lactation)
  • Food sources: fish, fortified cereals 
• Thiamin (B1) 
  • The brain can only use glucose as fuel and Thiamin helps convert glucose into usable energy. Without enough Thiamin, the brain may not have enough energy to function properly. Depression, anxiety, difficulty sleeping, among other symptoms are associated with low Thiamin levels. 
• Folate (B9)
  • Both folate and B12 are needed for the production of norepinephrine, serotonin, and dopamine which play important roles in maintaining a healthy central nervous system. Folate is especially important in creating healthy red blood cells. Low levels of folate have been linked to depression and anxiety. 
  • RDA: 9 -13 years: 300 mcg (males and females), 14-18+ years: 400 mcg (males and females), 600 mcg (pregnancy), 500 mcg (lactation)
  • Food sources: fortified cereals, dark leafy greens, kidney beans, oranges, avocados, Brussels sprouts 
• Omega 3’s 
  • Omega 3’s can support mental health by helping to lower overall inflammation as well as interacting with mood-related molecules within the brain. 
  • Studies typically suggest between 1-2 g/day (for reference, 1 /day would roughly equal 3 fatty fish meals per week). Since we also recommend Omega 3’s for IBD support, this is likely safe and effective for both mechanisms. 
  • Food sources: walnuts, fatty fish, chia seeds, algae