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New work helps to explain how chronic stress can inflame the gut (nature.com)
242 points by pseudolus 11 days ago | hide | past | favorite | 93 comments

For the past few years, I've had gut issues with a very unclear root cause. I was definitely under an insane amount of chronic stress due to the pandemic and isolation when the issues started, but after isolation ended and my life should have been less stressful the issues persisted. Some doctors seemed to take this gut-brain connection thing to mean that it was all in my head since they couldn't find anything medically wrong with me. That was incredibly frustrating because I was experiencing real physical issues like weight loss, hair loss, bloating, indigestion, etc. But all of the tests and biopsies they did came back normal. With functional medicine and a lot of trial and error with diet and lifestyle changes I've gotten to a point where I feel pretty much recovered, though still with a very sensitive gut. I never discovered the root cause of my problems. My leading theories are long-covid, non-celiac gluten sensitivity, or chronic stress. Possibly a combo of those things.

All of that being context, the thing I wonder about this is, if chronic stress does indeed inflame the gut, what does the process of reversing that inflammation look like? It doesn't seem like you can simply remove environmental stressors to undo the inflammation. It seems that there are feedback loops and damage that occur that can take awhile to undo. When someone has a stressful life, it can be difficult just to reduce the amount of stress, much less completely redesign their life to be less stressful. And gut inflammation makes it even harder. Even if they manage to do so, say perhaps by taking a year long sabbatical if they can afford to do so, removing the stress may not be an instant solution.

I hope more research is done in the area of healing from gut inflammation triggered by chronic stress.

To pull an HN evergreen and reply to the overly specific instead of your main point: My wife developed "histamine intolerance" after a time of heavy stress, in a story that's scary similar to yours. It took her years to figure it out, from chance result on a super broad blood test. To confirm this, she changed her diet to be only low-histamine foods and it made all the difference. She went from "a single chocolate chip cookie makes me sick for 3 days" to "mostly leading a normal life, just watch what you eat" in half a year or so. Over time it helped her gut recover to the point that she now generally does not need to watch out much anymore, except in some periods when some old symptoms pop back up and she reverts to low-histamine diet for a while.

Statistically speaking this is probably not it and you considered/tried it already, but just wanted to bring it up in the off chance that you hadn't heard of this before. I mean doctors just said "irritable bowel syndrome! theres no cure sorry bye". She's been writing a low-histamine foodblog for some years, which includes a good starting point for what to eat and avoid: https://histaminefriendlykitchen.com/histamine-friendly-food...

For years I had the same gut issues described by others here, seemingly caused by a combination of factors. I'll share what helped me solve the problem.

The most effective thing for me seemed to be hitting the gym hard, lifting heavy and sweating a lot.

Alongside that, I went through a lot of trial and error with the foods my body would tolerate. I started with a low histamine/low FODMAP approach, various fasting methods, bone broths (collagen), probiotics (sauerkraut, kefir), etc., and slowly introduced various foods on top of that while noting what made me feel good or bad and basing my diet around that. Everyone is different so what worked for me diet-wise may not work for you.

Lastly, for my particular case, I think liver-boosting supplements like milk thistle and NAC helped significantly (and probably some others for any vitamin/mineral deficiencies, especially D3+K2). I suspect the root cause of my problems was toxic mold plus stress/trauma.

Thanks for sharing this, and pass on my thanks to Tania too.

It's just uncanny to see a whole lot of the "random" foods that make me feel bad on a single list, and that number next to the anchovies explains the post-homemade pizza feeling too...

Will definitely need to follow up!

Meditation, mindfulness, reframing, emotional self-care, movement, exercise. The usual things.

Not trying to be smug.

But I noticed on a three week vacation, where I was walking 15K steps a day, I lost weight and had zero gut issues while eating freely in restaurants for the duration. Got home, day one the old issues came back. I definitely had a stressful association with my day job and the attendant life. I let a lot of things slip because I allowed that my situation required me to reward myself with lethargy and vices. When I’m above the baseline on self care, I don’t turn to the vices as much and my physical systems generally work better.

I got back into my “me first” routine and my gut issues subsided. For me it was like a switch.

I'm glad it was so easy for you. For me, I've been living like a self-care saint for over a year. Meditation, mindfulness, gym three times a week, active recovery, sufficient sleep, 15k steps a day, perfect diet, low-stress job, fulfilling sex life, morning sunlight, ice baths, saunas. I'm not OCD or up tight about it, but I'm very consistent. I get constant comments about how I take such good care of myself. A lot of people say they have never met someone who take such good care of themselves. But recovery has only happened very very slowly over the course of many many months.

It’s good to take care of yourself regardless.

But my experience is similar - I quit drinking in 2020-2021, eliminated grain from my diet, and eat probably 80% of my calories in vegetables now. Overall my body is in much better shape than it was then, but something is still wrong with my gut-brain axis. I think what the article misses is the microbiome factor. Any active microbiome is going to produce metabolites, and some of those metabolites can be destabilizing and disabling to the enteric nervous system, even if they’re not producing something as acutely toxic as a bacteria like C. Diff.

Of all the things I’ve tried, I’ve never felt as stress-free or clearheaded as I have near the end of a fast.

Out of curiousity, have you tried activated charcoal? It's not good to take frequently because it blocks nutrient absorbtion, but if I'm feeling really awful or just need to feel clear for a day so I can focus on something important, charcoal seems to mop up some of the toxic metabolites and give me a short break.

Yes, same – but taking too much or taking it for too long (basically taking more than 2g) seems to be abrasive to my GI system in a way that isn't helpful.

I understand how frustrating it is.

I had a food intolerance test. I replaced every item in my kitchen (new coffee maker [after ditching coffee for a while], new pots and pans, new cooking utensils). I did multiple elimination diets. I went to doctors (one doctor, when I said I had no issues in Europe and lots of issues immediately upon returning responded, with no mocking at all, I should consider moving to Europe) most of whom simply told me to go Whole 30 or Mediterranean diet (been there, done that).

I hoped a lot of it would subside when I eliminated the relationship in my life, too (alas, maybe.. not sure).

When I did the elimination diet the doctors said it could be a combination of things, it could be things that will take longer than a cycle of elimination to identify, etc.

They didn't know.

I guess there's always: therapy.

Wish I had a better answer, and not having answers is stressful enough. I did a lot of "letting go" and "eating freely" hoping a more carefree attitude would help. It always seemed like something else though.

My doctor friend says if he simply instructed all his patients to eliminate gluten from their diets he would still succeed with 80%+ of his patients having problems...

I'm quite a bit better, but given that my parents are European immigrants, I do think.. ultimately.. I'm better off back there in their food system.

the fact that for you, nothing works here and everything works in europe, points to a broad environmental factor - water, mold, air.

I went through it for many years. It got to the point where certain foods made me feel unwell. I had brain fog. Felt tired, exhausted. I changed my diet, cut out a lot of processsed foods and got by as best as I could.

In the end I realised stress was a major factor. Diet would have an impact but stress was the triggering agent that would make certain foods much more inflammatory.

I broadened my diet, ate much healthier. Made more effort to do exercise on a regular basis.

Slept regularly, slept earlier. Took time to go hiking or running long distances. Stopped thinking about work after hours. Made an effort to stop worrying about things outside of my control.

It took a few years and I reversed almost all the symptoms.

The main problem is with stress + gut issues, it's a downward spiraling feedback loop. Stress causes gut irritation, gut irritation makes you more stressed. I suggest going to a gastroenterolog, that knows about gut flora restoration. Basically you'll get a Low-FODMAP diet for a month, then RENEW diet for ~1 year, but you will also get a bunch of special probiotics, mostly based on Bacillus Subtilis.

During this time the negative feedback loop is being broken, the gut will have a chance to recover and the symptoms should improve/disappear.

I am slowly finishing this diet and I have to say that apart from a few ups and downs, it helped me tremendously. I have much more energy during the day, less oily skin and hair, smoother skin on my face, and consistent stool.

Stress is a catch all medicine uses when they have no idea.

Did anyone check your gut flora and provide an analysis, did anyone every take a sample before to compare to?

Diet changes is probably heavy protein, some greens, no carbs type style?

I'd recommend diving into probiotics, you'll get very little help from most doctors as they don't know shit about it (pun intended!)

Years and years of IBS like symptoms, like 20+ years of it. Probiotics, fermented foods, protein and greens...I shit like a god now.

Stress affects stuff, that's normal but it's never a single source issue when it comes to overall health.

If you ain't pooping right, solve that first.

I recommend an Organic Acid Test (OAT). I've been struggling with gut problems similar to yours for years but then it got so much worse during the lockdowns. At the time I survived it by embracing fasting and keto diets but that wasn't much fun.

More recently my OAT discovered fungal activity and an enormous vitamin C deficit. Potentially this has been going on for more a decade and it would explain why I'm so tired all the time. Treatment through supplementation is in the early stages but I'm already feeling noticeably better.

If you want to go a bit off the traditional path, you can look into BPC-157 which is a peptide that was designed to help heal the gut. Nowadays it's mostly used by athletes and anti-aging people to help heal soft tissue damage, but the original purpose was to heal your gut.

If you're in the US, you can probably find an anti-aging clinic with a doctor that you could ask about it.

I went way off the beaten path and got into peptides by way of kambo. It's an indigenous medicine that's very controversial with very little controlled scientific research, but it actually made a dramatic difference for me. Might look for into peptide injections, though it's harder to find them in my home country (Hungary).

I got recommended on a previous HN thread to try an L. Reuteri probiotic. This is the one I took: https://www.biogaia.com/product/biogaia-protectis-chewable-t.... There's decent clinical evidence for an effect[1].

The change in my gut health has been astounding. There was a period about 1.5 months after I started taking it when things definitely felt worse (which I guess is about the time the bacterial colonization was underway) but since then I've felt so much better it's incredible. About 1.5 years now with it as my standard and improvement is consistent.

Now for me this was a big improvement, but it works better (for me anyway) when paired with Questran Lite[2] which is prescription (at least in Australia) but has become the darling of GI doctors because it seems to have good results in improving gut health. I was on it before I started the L. Reuteri, but things only improved once I added the probiotic in.

So - in order: try L. Reuteri supplements for about 6 months (because it's OTC). If the gut inflammation is an issue there's evidence that they will in fact help reverse it. If things are still somewhat not great, get a Questran Lite prescription (though there's actually a global shortage going on now).

The L. Reuteri theoretically you don't need to keep taking, and I did try going off them for about 6 months recently, and was mostly fine but eventually started seeing some regression so started taking them again.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5917019/

[2] https://www.news-medical.net/drugs/Questran-Lite.aspx

I tried L. Reuteri. Probably heard about it on HN too haha. But for me that one didn't seem to make much difference. I had really good luck with BB536 though.

You might want to read 'The Lady's Handbook for Her Mysterious Illness: A Memoir' by Sarah Ramey (Known also from her band Wolf Larsen). She goes back and forth between providing an overview of this 'mysterious illness' from different angles, and her gutwrenching absolute trainwreck of a personal experience of it. It seems you already found your way the same way she eventually did, though.

As the title says, the book is womens body specific - but also a guy i still found it very insightful to read.

Another book to suggest, "The Comfort Crisis" by Michael Easter. In it he does a solid and helpful flyover on how humans evolved vs how we actually live now, and how the disconnect is impacting (negatively) our physical and mental health.

While there are few individual ah-ha moments, seeing everything laid out end to end to end aggregates into a realization that The First World lifestyle is extremely unhealthy and often (premature death) deadly.

Fwiw, in some ways The Comfort Crisis was like physical (and mental) health version of The Coddling of the American Mind, but without the PC-ish type baggage. Note: this comparison - for me - is a compliment as both books look to challenge mainstream narratives and normalizations.

I’d rather die of (first world) diabetes at an old age than (third world) malaria as a child.

What's your point? Do you have any value to add? Or is stating the obvious your superpower?

You don't have to be rude. This isn't reddit.

Your comment: ... "The First World lifestyle is extremely unhealthy and often (premature death) deadly".

My response: The First World lifestyle may be deadly, but I'll take that First World death over a Third Word death of malaria.

"what does the process of reversing that inflammation look like?" "that can take awhile to undo" think you answered it yourself. stress less and wait

Also, have a healthy and easy to digest diet, and don't try to eat too much (don't push too much undigested food through your gut, which will cause further issues by feeding the bad bacteria). Pre and pro biotic food may also help.

(in the spirit of "eat less, move more" for losing weight)

Like sibling posts say, inflamed gut leaks histamine, inflames it more and leaks more. Try low histamine and in general low processed and spicy food diet for a while to reset this feedback cycle. Good start: https://www.mastzellaktivierung.info/downloads/foodlist/21_F...

I tried a low histamine diet for a few months. Including DAO enzymes and histamine lowering probiotics. Didn't seem to make a difference for me. Eventually I found out that spicy food actually helps me a lot: it's anti-inflammatory and prokinetic.

After 6 months of testing different diets to try to solve my migraines, I eventually discovered an ultra-low histamine diet resulted in a ~90% decrease in my headaches. Then I began trying different DAO products before eating foods with histamine, but the headaches returned. I eventually discovered NaturDAO (available via Amazon) and its much higher 1,000,000 HDU per pill. Taking two of these before any meal or coffee finally worked to stop the food-induced migraines for me. Hope this helps.

I've been in biotech long enough to see that the beaten path (traditional drugs) does not have robust answers due to patentability.

Post-stress inflammation can persist due to latent infections of various kinds. To accelerated recovery, I would recommend a course of plant-based anti-pathogen treatments. (Not going to shill a specific one.)

My non-verbal son has autism and gastrointestinal issues. Unfortunately, all the pediatricians would test for is C-diff. After years of problems expressed in the most challenging behavioral ways(!), we finally had an MD (trained as a naturopath) prescribe a battery of pathogen tests (https://www.gdx.net/gut-health) that identified an obscure protozoa. Nearly, overnight difference upon treatment (a drug). The remaining GI issues were addressed with plant-based treatment. I've also suffered from GI issues that improved substantially with anti-fungal focused supplements (e.g., French Tarragon leaf).

I would recommend eating a diverse range of fermented food too (yogurt, real sauerkraut, etc), since they compete with pathogens for resources.

> plant-based anti-pathogen treatments

That's very very vague.

Sorry, I was trying not to advocate for any particular brand in this space. There are quite a few on the market and I don't have direct experience with more than a handful. They are all plant parts, dried, crushed to a powder, and put in a capsule. I have used Biotics Research (Dysbiocide and FC Cidal) and my son was prescribed a 90 day course from a different brand (don't remember off-hand). I'd suggest consulting with a naturopath, if you can find a reputable one.

Inflammation is an immunological reaction. It can be triggered a few different ways. Chronic inflammation is either because of a chronic infection or some sort of immune disorder. Chronic immune disorders don't just stop. They have a trigger and then keep going for the rest of the suffers life at some level. They can be controlled, but they can't be cured. This is because of the way the adaptive immune system works, which produces antibodies. Antibodies do a lot of different things, but one of the things they do is trigger inflammation in the presence of a specific protein. Your body has the capability of producing antibodies for basically any conceivable protein. Once an antibody is triggered, by having cell damage while the antibody is "activated." Your body replicates the B-cell that makes that specific antibody and the antibodies stick around in your blood stream. This is why you become "immune" after getting a vaccine, your body is able to "remember" the antibodies it needs to use in case you catch the real disease. When there is cell damage and the presence of another protein, your body could "remember" the wrong antibody. If it's environmental, this is an allergy. If it's from your own body, making the antibody attack some component of its own body, it's an autoimmune disorder. Once triggered, there's no known way to reverse that negative association. Immune disorders are also incredibly difficult to diagnose.

> When there is cell damage and the presence of another protein, your body could "remember" the wrong antibody.

I'm skeptical of this part. Aren't there always a huge number of proteins present in the body when cell damage occurs? For example, if I get a cold, and I eat chicken soup to prevent it, according to your explanation, I could develop antibodies for chicken soup. This doesn't seem to happen significantly often.

There are a lot of processes I skipped over. One of those is how the body removes B-Cells that react to benign or helpful proteins before they mature. But yes, if you had a B-Cell that produces antibodies against some antigen in Chicken soup, your scenario could lead to an allergy. The key is the body tries to select B-Cells that aren't going to produce antibodies that will be harmful to you. Sometimes it misses one and those are the ones that will cause an allergy or autoimmune disorder.

I’m in the same kind of situation, what functional medicine, diet and lifestyle changes did you try? What worked?

One of the resources that has helped me the most to understand this issue is https://www.monashfodmap.com/ by Monash University.

Tablespoon of apple cider vinegar during meals (mentioned this in the GERD thread, also helps with my gut and brain fog issues too).

There are a ton of rabbit holes you can go down for SIBO, leaky gut, gastroparesis, MMC, etc. All of them revolve around how fast and how well food transits your gut. Longer food stays inside you, the more problems you have.

I went off the beaten path of things proven by clinical research. So none of this stuff is more than anecdotes, but some of the things that helped for me: digestive enzymes, oregano oil, gluten-free diet, probiotics (BB536, and kefir), mastiha tears, kambo, vitamin B, organ meats. I'm currently refining my daily supplement stack.

Things that don't kill you make you weaker. The other saying only applies to mental hurt, not physical.

From my experience, there's nothing you can really do to fix this beyond 'live a normal healthy life, and let it heal itself, slowly, and not fully.'

I worked at a hospital (in IT) during covid, had to be onsite a couple of days a week. lots of people dying all around, n95 all day, etc. not a problem. As I settled in, I realized my manager, and the director, were absolutely toxic people on a powertrip. they didn't care if you said "this is likely to bring down random hospital applications, we need to do it this other way." 2 stars on glassdoor, cowboy hats all around, staff morale not present. they'd come up with technical ideas on how to do something, despite being barely technical people. telling them how to do, say a data migration online, because you're an SME who's been doing it for almost 30 years is a personal challenge, and you get crapped on, overruled, and put in your place. Lots of downtime, lots of patients affected, yet they report literal fake status reports up the chain and generalize-away every issue to the point that the generic statement hides the issue.

I started getting heartburn during the day. Then I started getting hearburn in the morning as my alarm rang. Then I started waking up 5min before the alarm rang, with heartburn, and teenager zits on my face at mid-life. Morning was now a cup of baking soda water instead of coffee. ion pump blockers. more baking soda.

after 6 months, the manager ordered me to execute a migration plan that would shave off 2 days from a year-long plan. I made a nice writeup stating we need to monitor sockets on the array a few days to make sure people aren't actively using the data she want's to trash. Last time she had me do this, she asked over email, and it brought down a whole clinic that was using a share she thought was unused. This time, I was asked not over email, but with a call from her cell phone, to my cell phone.

I said no problem, send me an email or type it in chat, and I'll do it despite the high risk. I was of course fired 5 days later, but already had a new fully remote job, which I started 5 days earlier (lol).

The point of the story is - the stomach issue didn't go away. 3 years later, it's still there. It's much less, but that last/final bit, where a couple of times a year I need ion blockers for 2 weeks, and maybe one day a week I still need to start w/ baking soda water - that's probably there to stay. I eat very healty, lots of fiber, I'm fit. That 6 months of acidic people did damage that a middle-aged body can't heal all the way.

There's nothing you can do. This is your new thing now, have fun with your new friend. And watch this: https://www.dailymotion.com/video/x6xc3r7

I am about five years out from a similar situation, so let me give you a glimmer of hope: I did get better, very slowly. I wish I could say why, I’ve obviously tried all sorts of things and also a lot of life has happened between then and now, but _don’t give up hope_

And best of luck, I suspect you really helped some patients at your former job relative to someone who would have been less conscientious. Maybe even me, we’ll never know!

I have a friend who is a Nurse Practitioner. In Canada this is pretty close to a doctor in that they can order tests, diagnose patients and prescribe treatments and medications. She was in private practice for a while.

She talks often about how the most common complaint she saw by far is gut distress with no medical cause. It is so common that the medical professionals call it SLS: Shit Life Syndrome [1]. She argues that the vast majority of the people who come in with this complaint have an undiagnosed mental problem. Our systems aren't built to handle this kind of situation. We find and treat acute problems and we don't really address holistic life-style issues. In fact, it is frowned upon. What she usually wants to say is: your life sucks, fix it and you will feel better. Go out for a walk, eat healthier food, make some supportive friends, engage in some self-care, meditate, etc.

I personally believe that a lack of purpose in people's lives is manifesting as pain in our bodies. But that is dangerously close to woo-woo New Age thinking and most people will just reject it off-hand. Instead they will try magnesium pills, apple cider vinegar, avoiding gluten, anti-inflammatory diets, micro-dosing lsd or mushrooms.

As a side note, she also mentioned that the newest fad (not quite at gut distress levels yet) is middle-aged men insisting they have ADHD, demanding diagnosis and prescriptions.

1. https://en.wikipedia.org/wiki/Shit_life_syndrome

> As a side note, she also mentioned that the newest fad (not quite at gut distress levels yet) is middle-aged men insisting they have ADHD…

The reason for this "fad" is straightforward — there are a lot of middle-aged humans who are undiagnosed because ADHD was effectively "not a thing" when GenX were kids.

> …demanding diagnosis and prescriptions.

Great! People of all ages should advocate for themselves and pursue health care that might improve their quality of life.

> The reason for this "fad" is straightforward — there are a lot of middle-aged humans who are undiagnosed because ADHD was effectively "not a thing" when GenX were kids.

Or to the extent that it was, they only knew of it through narrow or outright inaccurate stereotypes. It's become a somewhat common story over the past few years in online ADHD communities for Gen X and older Millennial parents to get their kid diagnosed and have a "wait, that's not normal?" reaction to the explanation of how the condition actually tends to manifest.

But I think it was normal. Would modern undiagnosed children have flourished in less institutional settings? I think being on the dangerous edge used to be safer than being insufficiently experienced in dangers that were unavoidable and in many cases predatory.

ADHD have symtoms that could fit anyone. It is about a threshold.

I think "advocate for themselves" can be reductive. There is a spectrum of advocacy.

One approach is to work with a medical team over time to document symptoms and impact on your life, experiment and document attempted treatment alternatives, escalate to appropriate specialists as necessary, etc.

Another approach is to spend a weekend reading blog posts, forums and chatting with your bros, then convincing yourself of a particular syndrome/disease you must have, urgently scheduling an appointment with a brand new medical practitioner, refusing to discuss your medical history or symptoms since you already know everything, demanding a particular and specific treatment, refusing to discuss alternatives and then becoming hostile and aggressive when that practitioner doesn't immediately write you a prescription for the particular medication or expensive test that you have already decided that you need.

That second approach is a caricature that unfortunately approaches a modern reality, and it isn't what I'd term as "Great!" for anyone involved. The first approach is equally horrible since our system is so back-logged that the amount of time and personal effort between starting the process and receiving the help you need is onerous.

Note that this applies equally well to gastro-intestinal distress as it does to ADHD or any other chronic condition.

> There is a spectrum of advocacy.

There are plenty of "pill mills" and "scrip doctors", and plenty of patients who will abuse that gray-market system. That is not what I'm referring to when I talk about self-advocacy by people who need actual, legitimate help.

Watch how the lens deforms the content. You "drank the koolaid" on this one. There's a mental trick there, an inversion.

Ritalin is a stimulant that tricks the brain into believing it needs to perform and focus.


"I have ADHD, so I need my Ritalin to be normal"

is equivalent to saying

"I'm depressed and anxious, so I need my cocaine to feel normal"

It probably does help! If you are stuck in a rut, external tools can break you out and show you what the other side is like. But using drugs is basically lying to your brain.

> What she usually wants to say is: your life sucks, fix it and you will feel better. Go out for a walk, eat healthier food, make some supportive friends, engage in some self-care, meditate, etc.

It’s almost like we haven’t collectively created a society that aims to increase human flourishing and instead of created a living nightmare with the illusion of progress due to shiny new technologies.

This, so much this. My family often jokes about how I'm the health and fitness "freak", because I care about my wellbeing and stress levels. However, this is very normal in my social circle - and I would argue - in my class and generation. A few examples come to mind:

- The rise of social/fitness loci. Young people socialize through sports, cycling groups, climbing gyms. - The advent of data-driven fitness. So many people have wearables, sleep trackers, follow the science behind health (Huberman podcast, Rhonda Patrick, etc.). - More people are opting for healthier living, generally (regular bedtimes, stopping or greatly limiting drinking, removing stigma from mental health diagnoses).

It feels like this generation is the first to really prioritize physical wellbeing as a primary driver of overall quality of life. I sincerely hope this trend sticks, and we look back 20 years from now and are surprised that so many people for so long neglected the fundamentals of health.

Middle aged man with ADHD here. Just found out. Didn’t want it. Although it explains a lot of my almost 50 previous years. I am now sad.

> Although it explains a lot of my almost 50 previous years. I am now sad.

It's a matter of perspective. I find it a relief that many things I thought were my moral failings were simply predictable consequences of a common problem.

> middle-aged men insisting they have ADHD, demanding diagnosis and prescriptions.

My opinions on the matter, as someone with ADHD, is that I do not personally believe that treatments that can improve one's life should be gatekeeped (gatekept?) sheerly by disorders. In other words, if people have symptoms and medicine has the tools to treat said symptoms, then such tools should be used regardless of the condition. If one is struggling to achieve a life that is within their potential, then why should they be denied something that can assist them? It would be like saying, "only paraplegic people are allowed to use wheelchairs. It doesn't matter if your legs are broken, they still technically work, thus you don't deserve to use a wheelchair." It's not like various psychostimulants commonly used for ADHD weren't used for 70+ years prior to being indicated for ADHD and other conditions.

Personally, I have always hated the false dichotomy of either one having ADHD or not. I do not think it's that simple, and it is surely not a binary condition. The condition is nothing more than a label assigned to an arbitrary set of symptoms. Even the diagnostic criteria is not all encompassing of the many symptoms people with the condition struggle with.

Just thinking about the various people I know in my life, I would confidently say not all them have equal attention spans, executive functioning, etc.. So, what's the arbitrary cut-off?

Another issue that ADHD (and many other conditions) is that there is absolutely no way beyond a reasonable doubt to prove who has the condition and who does not. There is not a single biomarker -- no gene test, no urinalysis, no blood marker, no fMRI brain scan, etc. that can be used to definitely diagnose the condition in a clinical setting. The diagnosis is just a professional and clinically informed opinion using heuristics.

How was I diagnosed? I went through a gauntlet of exhausting interviews and somewhat pseudo-scientific psychometrics -- WAIS IV IQ test, Stop/Go test, and plenty of others that I cannot remember the name of. It's about as legitimate as one can hope for currently... or at least a decade ago.

With all the being said, I definitely think it's a completely real condition, I just think we are operating on a model similar to the Plum Pudding Model of the atom -- it's not completely wrong, but definitely not correct -- but it's the best we have at the moment. The question I often ask myself is that, "Is there something actually wrong with me, or is something wrong with the world we live in?" For me personally, this disorder has no negative health affects other than making me completely incompatible with this world. I mean, I'm within in the range of average height for adults males. My height causes me no issues in my life. However, if I were to play in the NBA, it would cause all kinds of issues. Does that mean I would have a height deficit disorder?

One more thing about the medications, people have no idea what they are messing with. Sure, stimulants would help a majority of people be more productive (caffeine/nicotine are common for a reason), but nothing in life is without a cost. They absolutely help me live a life that I would unlikely be able to without them. That doesn't mean they are sunshine and roses. In some ways, I feel like I made a deal with the Devil. I have had many friends with ADHD and many friends without ADHD that lied to get access to the medications too. I've seen these medications help people reach the heavens, and I have seen these medications drag people through utter Hell.

Anyway, sorry if this is all over the place and somewhat pointless. I do have ADHD after all. ;)

I really appreciate this response.

> I do not personally believe that treatments that can improve one's life should be gatekeeped (gatekept?) sheerly by disorders

In my most libertarian moments I totally agree. But I also accept (even if I don't agree) that a large number of people believe that the detriments to society as a whole (including to some individuals in particular) caused by the misuse of powerful and addictive substances outweighs the benefits of un-controlled access.

> How was I diagnosed? I went through a gauntlet of exhausting interviews and somewhat pseudo-scientific psychometrics -- WAIS IV IQ test, Stop/Go test, and plenty of others that I cannot remember the name of. It's about as legitimate as one can hope for currently... or at least a decade ago.

The "fad" I was talking about was individuals showing up to a medical professional and having the totally unrealistic expectation that after a one hour consultation they would be diagnosed with a severe mental disorder and that they would walk out that same day with a prescription for a controlled stimulant.

The real path to treatment in our system is much more difficult. You have to demonstrate and document a history of symptoms and their effects on your life. It can take 6-12 months in many places to get into a specialist like a psychiatrist. Then it can take many more months of experimentation with alternative treatments before being prescribed medications.

That path is, frankly, atrocious. We are so starved for qualified resources that the system purposely slows things down. If you are able to work and live life even minimally - you are low on the priority list in many cases. There are enough truly horrible cases (severe schizophrenia, bipolar, etc.) that involve people unable to function at all that those who are merely suffering can get ignored. Front-line medical workers gate-keep access to specialists out of necessity, not out of malicious intent.

The patience you demonstrated to get the help you need is commendable but also proof that the system delivers for those who need it.

The alternative path that many choose to take is to become hostile, aggressive or abusive. They refuse to push through the system or to even attempt alternatives. They demand a specific diagnosis and a precise medication and they get angry when they don't get it.

> In some ways, I feel like I made a deal with the Devil.

This is is one reason why the system pushes people to try every alternative possible before going down the route of medication. If someone can find any alternative to medication to manage their symptoms - they ought to avoid the diagnosis and avoid the medicine.

It is just the case that many possible alternatives, including life-style changes, are explicitly forbidden to talk about. So while the medical practitioner may want to say: you need better friends, a better job, a better life in general ... they often cannot. Nor are some aggressive and hostile people willing to listen even if they could.

> But I also accept (even if I don't agree) that a large number of people believe that the detriments to society as a whole (including to some individuals in particular) caused by the misuse of powerful and addictive substances outweighs the benefits of un-controlled access.

I completely understand where you are coming from. I really think it is a detrimental society that pushes people into that direction. I have noticed that I mainly take stimulants due to the demands of other people. Do I care if my project is not completed on time? No. Does my employer? Absolutely. I wouldn't be surprised if some of that parallels with others. I hate having to kill myself from the inside out just to function in this world, but I do what I have to do in order to survive.

> The real path to treatment in our system is much more difficult. You have to demonstrate and document a history of symptoms and their effects on your life. It can take 6-12 months in many places to get into a specialist like a psychiatrist. Then it can take many more months of experimentation with alternative treatments before being prescribed medications.

This is where I had a wildly different experience. I guess it is probably because I am not part of the "fad" you are talking about. However, my university had a psych on staff. I scheduled an appointment with him, and I saw him in like a couple days afterwards. He did a basic interview with me, and based on just my behaviors, mannerisms, etc.. He chuckled and said, "You are so ADHD. However, I need to you undergo formal testing out of policy, you should go to <insert name of place.>"

So, I scheduled an appointment, and did all the interviewing testing in two or three sessions, and I was being treated in like two weeks or less. Alternative treatments were actually never even attempted nor suggested. It was straight to medications.

I've still not had many issues getting into doctors, and perhaps I am just very lucky in that regard. I recently left my most recent psych and moved to my GP. He will only treat me because I have a formal diagnosis (e.g. documentation "proving" it). If a psych or another doctor diagnosed me and treated me, that would not be sufficient because my GP claims there wouldn't be enough "evidence" to prove I have the condition. So, I do feel bad for many people who were diagnosed in less formal ways.

I am all for the alternative path, and I am starting to investigate how to go down that path. I have not been very thrilled with psychiatrist. I have many qualms with how psychiatry as a field operates. I am not anti-medicine by any means, but I have never seen nor heard of such a punitive and unscientific field of medicine. Never forget, it's the only field of medicine that can make patients take medicine against their will and involuntarily hold someone against their will.

If you are diabetic, a doctor can prescribe you insulin, but the doctor cannot force you to take the medication. The doctor cannot not commit you despite the fact that abstaining from insulin would cause direct harm. Psychiatrist, however, do have that option depending on the case and the patient.

I have seen around 10 or more psychs/psych NPs in my life. I have always hated how I have had to walk on eggshells around them, so to speak. I feel like they have never taken ADHD seriously and that they act like they are doing me a favor and that I should get on my knees and kiss their feet. Medication not working well? Don't you fucking dare ask for a dosage increase -- what are you some kind of addict?

Not to mention all the random drug tests. Do they test for alcohol or tobacco -- two of the most damaging substances on the planet? Absolutely not. Take CBD with negligible amounts of THC, but enough to pop hot on a urinalysis? Doesn't matter, you are a drug addict. Kiss your prescription, your job, and your life stability good bye. In fact, my previous practice would refuse to treat you and would kick you out of their practice. We had to sign "Controlled Substance Agreements" and all this other horseshit.

Substance Use Disorders are so correlated with ADHD that they are damn near a symptom of untreated ADHD in teens/adults. What field of medicine punishes patients for a medical disorder -- isn't a SUD a valid medical condition? Should a diabetic have their treatment revoked due to a SUD? Not to mention, ADHD medication has plenty of research to back that it does not worsen and may prevent the development of SUDs in people with ADHD.

> So while the medical practitioner may want to say: you need better friends, a better job, a better life in general ... they often cannot.

I completely agree. In fact, I have noticed that myself. I am quite depressed as of lately, however I do not think there is something wrong with me. In fact, it's the opposite. My mind/body is working correctly. I am not in a good place -- miserable job, almost no social life, no hobbies, no goals, no passions, etc.. I mean, who wouldn't be depressed? However, I have been making small steps in the right direction (this isn't my first rodeo). I beat depressions ass many times before, and I will do it again. I refuse medication for it because I feel it would hinder my from making the right steps, and would rather sedate me enough to tolerate my shit situation -- it's what happened last time.

> If someone can find any alternative to medication to manage their symptoms - they ought to avoid the diagnosis and avoid the medicine.

I support this practice too. I do not think medication should be the go-to unless it is completely warranted. Besides, I hate to say it, but honestly, I am not really sure the ADHD meds work all that well to begin with. I often joke that I swear they work better for people without ADHD than those with it.

I mean, are they better than nothing? Absolutely. I still take them for a reason. However, they are far from a silver bullet. I feel like I get about 25%-50% reduction in symptoms, which is enough to help me achieve stability to some degree, but I wish they worked better. The average non-ADHD person is still probably far more productive than I am. Thus, I have been really been considering alternative approaches. It just seems no matter what I do I will always revert to the mean. Maybe that's just how I am supposed to be. =)

This disorder and the trauma that is has caused me will probably always hold me back in life. But hey, in the grand scheme of life, I have a lot to be thankful for, and I am lucky I do not have a worse condition. I'll never be a FAANG developer or work at some fancy start-up, but there is more to living a good life than a maxed out career.

Newest fad, trying to get legal amphetamine.

Whoa. I have been struggling with this issue for a long time. My gut has turned very sensitive and bloated. I could have a hard day even if I have strong coffee. Let alone skip a meal. My medical diagnosis doesn't show any problem with my stomach or gut. I used to smoke and there used to be times when it was stressful at work and I believed it was natural for anyone these days. After 2 years of stoppinh smoking + taking care of my diet + medicines it is still not gone completely. It's uncomfortable to live with this.

If we look at this research and also look at the recent analysis that 1/10 people have some kind of autoimmune disease like Crohn’s then it seems safe to conclude that stress is literally slowly killing us.

Seems like the root issue might just be society wide stress and anxiety at levels and at a scale never seen before. We can jaw all day about how GDP has never been higher and how much TV there is to watch now, but we’ve never been chronically sicker and we’re trending the wrong direction.

I had a GI tell me every time I visited him that stress has zero connection to the manifestation of my Crohn's symptoms. Yet here I am; years later, I'm off all the meds they prescribed and 95% of my days are symptom free through keto dieting and yoga to manage the stress. The stress of the corporate world was literally killing me, I do much better working on startups - a different kind of stress.

Agree. A lot of people talking about cures here (and a lot of pseudoscience), but not a lot of people exploring the societal psychological aspect. I've noticed a lot of people, especially younger people in America, creating their identity entirely around consuming things that are short-lived trends. It really leaves people empty once the tide goes the other way. It's like systemic insecurity. I'm wondering how fostering more concreteness in our culture (as well as workplace structure changes) could help with this, but I have no idea how to approach it from the ground up.

I’ve often wondered if huge amounts of stress as a child could cause celiac disease, or be one of the factors. As the child’s body is developing, having parents go through a divorce or experiencing a death in the family, could create life long physiological effects.

Van der Kolk's and other similar research seems to show a pretty strong correlation between childhood trauma/ptsd and adult inflammation disorders. IIRC the gut link gets a small chapter in the famous book he wrote about that research.

Kids are simply raised in a fairly fragile way, where strengthening psychological resilience is completely ignored in the upbringing process.

Psychological resilience is difficult to study directly or even define, since experimental isolation or testing of it in children is almost definitionally unethical.

But what a large body of research shows is that the most psychologically resilient adults are those who were not forced to demonstrate emotional fortitude in childhood. This makes intuitive sense too, otherwise you'd expect to see adult children of addicts, war orphans, grown child soldiers etc having the most stable temperaments, a thing that is just notoriously not the case.

Absolutely. It's like having the expectation of being manly for boys. There is a pressure for being masculine, but no focus on developing the tools for masculinity. Simple the requirement of it.

After a really really bad (prolonged) work situation, I started getting wicked acid reflux—with a very clear trigger between stress and subsequent symptoms. I remember at one point opening a passive-aggressive email from my boss and instantly feeling like a battery had exploded in my mouth.

The reflux never went away, even after my work situation improved, and some other gastrointestinal symptoms worsened until I recently got diagnosed with Crohn's disease. Which I am genetically predisposed towards, but I still like to say that my shitty boss gave me Crohn's (and not entirely in jest).

Although drugs have helped both issues immensely, I will say there's a pretty substantial link between my symptoms and bouts of stress. A lot of people with IBD (and to some extent, IBS) are all too aware of the paradox that if you spend too much time worrying about the possibility of a flare-up, you're all but guaranteed to have a flare-up. The tummy is a fickle beast!

One big open question for me is what my body counts as stress. I have had short, objectively stressful situations, which had no impact. My longer-term stresses feel like they are more of the style “it’s a job, that is why they pay you“ but switching jobs might have helped? It’s not like I can do that enough to get statistical significance. And I don’t think an outside observer would consider my new job definitely less stressful than my old one, but there might be some dimension, which is really important to some subconscious part of me. And I don’t think an outside observer would consider my new job definitely less stressful than my old one, but there might be some dimension which is really important to some subconscious part of me.

That’s part of the reason that I resisted the stress explanation for so long: even if you accept it in general, it’s very unclear what to do about it, so I wanted to keep exploring more tangible causes

Evolutionary, stress helps an animal to survive an imminent danger. Stress (glucocordicoids) divert your energy to either flee or fight. Digestion? It's not important if survival is at stake. You can survive with a bloated stomach but not a missing stomach.

If stress is chronic then you get the bad stuff all the time.

I would just like to point out that in the space of two decades we've whipsawed between "ulcers aren't caused by stress, they're caused by bacteria" to "no actually ulcers might really be mainly caused by stress."

Many such cases. I once wondered whether my decision to not pursue a PhD in physics was a mistake, but I increasingly believe we live in a Dark Ages. It is impossible to take the vapid Science as an institution seriously, especially when it embraces this myth of science being constantly correct.

(And yes, I understand there's a difference between scientific press and actual scientists. And no, you're wrong if you think their self-esteem or general sheltered Mickey Mouse worldview around their importance is any different than the public press.)

Could the ulcer question just vary based on the type of ulcer? I know that h. pylori is a big culprit in people who have ulcers but are otherwise healthy, but IBD causes ulcers too (putting the "ulcerative" in "ulcerative colitis")—and since stress is a driver of IBD flares, those are certainly ulcers by way of stress. But they occur in different portions of the gut, usually.

Absolutely does, there are multiple causes of ulcers. Canker sores in your mouth are caused by either stress or vitamin deficiency and they're still "ulcers". And what H. Pylori does is a huge cause of gastric cancer, so pathogens damaging the body is a factor. I agree with the top comment of this tree that we can't see science as set in stone, but many things have multiple causes that work separately or synergistically

Yes ulcers are just erosions of the inner layers of stuff. You can have ulcers in your arteries too.

> "ulcers aren't caused by stress, they're caused by bacteria" to "no actually ulcers might really be mainly caused by stress."

Por que no los dos? H. pylori needs to artificially buffer its micro-environment in order to survive. Anything which disrupts the production of stomach acid or digestive proteins could give it an edge.

Anecdata of 1, but I had a bout of bad chronic heartburn after eating at some sketchy food joint. I was popping omeprazole like crazy. Somehow in researching this, the topic of hydrogen forming bacteria came up. I somehow hypothesized that PPIs were actually exacerbating the problem, because the higher pH was allowing the bacteria to survive. I put myself on a high prebiotic/probiotic diet, stopped the PPIs and antacids, and it resolved completely by a few weeks later. I could easily see a similar thing happening with heliobacter.

Ulcers are not all the same just like cancer is not all the same. H pylori still causes gastric ulcers.

Also the “medical-science” institution you are imagining with a collective self-esteem doesn’t exist in any cohesive way. You memorize, read, diagnose and treat.

And please don’t lump us in with phDs

We have decades of partial answers as to how the brain affects the gut, but none are anywhere near complete.

This finding, that some gluco-corticoid derivatives inhibit cell maturation, is new in its specifics but there was plenty of evidence to suggest the hypothesis. But it's a tiny part of an entire ecosystem. People are already told to avoid NSAID's, so it will have little clinical impact.

Saying "autoimmune disease" is as precise as saying you have a performance problem in the cloud. Worse, people mistakenly use that term for any chronic immune-system-mediated syndrome.

Even worse, saying that "People are sick because society is stressed, so we should reduce stress in society" completely misdirects useful resources. People who want to do good need to dig in and do the work, not hand-wave.

Chronic immune-mediated diseases fall in the crack between primary care and GI specialists. The specialists only have time for surgery or drugs, and primary care doesn't have the expertise for the patient months-long self-experiments required to isolate relevant factors (among diet, stress, infectious disease, microbiome, genetics).

This is a structural health-care opportunity for anyone able to take it. Private equity could fund practice groups with a few doctors and 6:1 advanced-practice providers, partnered with diagnostics and EHR peers, carefully working through and evolving GI algorithms and diagnostics. The alternatives (surgery and drugs) are expensive and ineffective and the incidence is high, so the market is definitely worth pursuing. Longer-term, it may help with automating the actual practice of medicine, where each patient is an experiment with a series of knowns, some negotiated interventions, and a track record of results: all invaluable data for this case and those like it, and a methodology applicable to other chronic immune diseases. Automating the accumulation of expertise scientifically in a practice system is really the future of computers in medicine. It will never happen via diagnostics (Quest, LabCorps) or EHR (Cerner/Epic) because their virtues are contra-indicated in the continuous experiment of treating chronic disease.

Did anybody else seem to get better after COVID forced a work from home?

I did not think of my commute as especially bad, nor any other part of being in the office, but the timing is pretty coincidental

I had some gut issues and switching jobs to WFH friendly made it all gone away. It's much easier to change your bad habits when you have more control of your environment. It wasn't in COVID times though, it was around 2015.

I actually did great for the first few months after switching to WFH, until other stressors overrode any benefit and messed me up in other ways.

Unlike the article and other posters in this thread, I have an entirely biological viewpoint on the matter. I think there is ample reason for GI disturbances to exist from chronic chemical insult from tens of thousands of compounds present in our food for which our bodies did not evolve to tolerate. I think the experience of stress over the matter is a natural consequence of disturbances in normal organ functionality. The same stress happens when other organs have issues. What is the purpose of psychological stress if not to motivate the organism for change and a need for adaptation? With what I have learned in the past 10 years of medicine and biology I am almost thoroughly convinced that every single thing is physical and some day will have far better solutions that make people drastically more capable resilient and stable and so many practices and denominations that exist today will be archiac antiquity.

I first got IBD when I was 18 and preparing for the final high school exams that decided which university I can get to. Then I got it under control, but it returned several times, always when I was under a lot of stress.

BTW asthma also gets much worse with stress

In mice.

It's nothing more than an anecdote, but I can't help but correlate the fact that I was diagnosed with colon cancer in late 2016. I joined as one of the first 12 employees of a startup a few years earlier and I can absolutely say with respect to stress and nutrition it was one of the roughest periods of my life.

Hope it’s really that simple.


and how in todays world do you feel we can avoid stress?

Actually my gi physician has ibd pts see a therapist on every yearly visit

Doesn't answer my question - why? Is there no point to any of it?

So did IBS go away when they gave people relaxation courses and stopped them watching YouTube videos about nuclear annihilation?

I know your comment is tongue-in-cheek, but in my experience chronic stress is more caused by financial hardship, bad relationships, overwork and other daily life stuff.

(I wrote my comment before you massively edited yours)

> chronic stress is ... caused by financial hardship, bad relationships, overwork and other daily life stuff.

Or living in / growing up in an environment where these are the major concerns. Cycles, etc.

Not sure mice are worried about human annihilation ...

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