Connection and management modes

Numerous studies suggest a bidirectional relationship between a person’s gut and mental health. Probiotics and diet can help a person improve both.

According to the National Alliance on Mental Health (NAMI), anxiety disorders are the most common mental health concern in the United States. At the same time, digestive diseases report 100 million outpatient visits per year.

Research examining whether anxiety and gastrointestinal disorders are linked has focused on the “gut-brain axis,” a complex communication system between the two organs, and the role of microorganisms in the gastrointestinal tract of humans.

This article explores the relationship between gut health and anxiety, gut problems that cause anxiety, symptoms of anxiety, and ways to manage anxiety and gut health.

The gut or gastrointestinal (GI) system is a series of organs, nerves, hormones and bacteria that work together to activate digesting food. The brain is directly connected to the gastrointestinal tract through the central nervous system (CNS), and signals flow between the two to control certain aspects of digestion.

Learn more about digestion.

Another important control center, the enteric nervous system (ENS), is located in the GI lining. The ENS has 100 million nerve cells and can work independently of the brain. Scientists believe it may play a role in the connection between the gut and a person’s mental health.

According to a 2015 review along the gut-brain axis, the ENS and brain communicate to control gastrointestinal processes, linking cognitive and emotional functional centers in the brain to GI mechanisms. Researchers suggest that this communication system may influence motivation and higher cognitive function.

Experts believe that the ENS can also cause major emotional changes in people suffering from irritable bowel syndrome (IBS) and other digestive disorders. Irritation in the gastrointestinal tract can send signals to the CNS that cause mood changes.

How does gut health affect anxiety?

Numerous studies have focused on the relationship between gut microbiota and anxiety. Gut microbiota is a system of microorganisms in the gastrointestinal tract of a person, inclusive trillions of bacteria, fungi and viruses that the body needs for optimal health.

Gut microbiota plays an important role in regulating the immune system and processing energy from digested food. Changes in the microbiota can affect these functions, and scientists believe that mental health may also be affected.

A 2019 review suggests that stress and depression may alter gut microbiota composition through stress hormones, inflammation, and autonomic changes. The gut microbiota responds by releasing metabolites, toxins and neurohormones that can alter eating behavior and mood.

A 2017 review further explored this relationship, suggesting that inflammation in the gastrointestinal tract places stress on the microbiota through the release of cytokines (small proteins) and neurotransmitters. Researchers suggest that increased levels of inflammatory cytokines directly correlate with symptoms of depression and anxiety.

Learn more about inflammation here.

IBS, a gastrointestinal disorder involving inflammation and putative changes in the gut microbiota, has a co-occurrence between 44 and 88% with anxiety and depression. More research is needed to determine whether this relationship is causal.

The above 2015 review cites animal studies showing that the microbiota also influences stress reactivity and anxiety-like behavior. According to a 2021 review, the gut microbiota plays a role in the development and functioning of the hypothalamic-pituitary-adrenal (HPA) axis. The HPA coordinates a person’s adaptive stress response, and a dysfunctional HPA is often associated with anxiety and depressive disorders.

Gut microbiota also regulate the production of neurotransmitters such as serotonin, a chemical that scientists believe plays a role in stabilizing mood.

Everyone experiences some form of anxiety. But if a person experiences excessive worry that prevents them from going about their daily lives, they may have an anxiety disorder.

According to NAMI, anxiety disorders are a group of related conditions, each with unique symptoms. But people with anxiety disorders usually experience constant fear or anxiety in situations that are not threatening.

Anxiety and depression are both connected with prolonged low-grade inflammation. People with inflammatory diseases that involve suspected changes in the gut microbiota, such as IBS, also have a high co-occurrence of mental health conditions such as anxiety and depression.

People with an anxiety disorder may also experience one or more of the following symptoms:

Learn more about the symptoms and signs of anxiety.

Several treatment options can help people manage anxiety symptoms.

Health professionals may recommend a combination of methods, and treatment will vary based on a person’s symptoms, preferences, and overall health.


Psychotherapy or “talk therapy” is a general treatment for concern. Several types are effective for anxiety disorders, including:

  • Cognitive behavioral therapy (CBT): Numerous studies have shown the efficacy of CBT in the treatment of anxiety disorders. CBT focuses on finding strategies to reduce beliefs and behaviors that contribute to anxiety.
  • Exposure therapy: This behavioral therapy can help people overcome specific phobias. Psychiatrists guide people to expose themselves to situations or stimuli that cause fear or panic; over time these feelings diminish.
  • Acceptance and Commitment Therapy (ACT): This type of therapy uses goal setting and mindfulness to reduce anxiety. ACT is a newer form of psychotherapy, but research links ACT to improved mental health and quality of life.

Learn more about types of therapy here.


Healthcare professionals might as well prescribe medication to treat anxiety disorders. Medicine is not a cure for anxiety, but it can help relieve symptoms.

The most common types of medication for anxiety disorders include:

Learn more about the different types of anxiety medications.

Relaxation techniques

There are various stress relaxation techniques that a person can try to reduce anxiety, including:

A 2019 survey surveyed 1,151 adults, including those who meditated and those who did not. Researchers found that mindfulness reduced anxiety by increasing cognitive reappraisal (an emotional regulation strategy) and decreasing worry, rumination, and suppression of emotions.


A 2020 survey found that physical activity protects against anxiety disorders in clinical and nonclinical settings. Exercise, part of physical activity, also significantly reduces anxiety symptoms.

The mechanisms by which physical activity reduces anxiety symptoms are unclear, but researchers believe it is likely to be a combination of biological and physiological factors.

Learn more about anxiety exercises.

Scientists believe that taking steps to improve gut health can also help manage anxiety.

Research has focused on the benefits of adding probiotics to one’s diet and promoting healthy gut bacteria through diets high in fiber and low in saturated fat.


Probiotics are living microorganisms found in fermented foods and nutritional supplements. Probiotics can help a person’s body maintain a healthy community of microorganisms or help it return to a healthy state after it has been disturbed.

Learn more about the health benefits of probiotics here.

Various studies have investigated the potential of probiotics to restore the balance of gut microbiota that has been disrupted by stress and anxiety, and whether this improves symptoms of anxiety.

A 2021 survey show a potential link between probiotic-induced gut microbiota regulation and stress/anxiety relief in stressed adults. and a 2019 survey showed that ingestion of the probiotic strain, Lactobacillus (L.) plantarum P-8, for 12 weeks can relieve stress and anxiety in stressed adults.

A 2019 review it also highlights a study involving Japanese medical students in which probiotic supplements improved sleep, autonomic balance, and bowel habits and reduced stress and cortisol levels.

Fermented foods are a natural source of probiotics. Common types include:

Learn more about the best probiotic foods for a healthy diet.


Researchers have also investigated how diet can affect a person’s gut microbiota and how this relates to stress and anxiety.

The 2019 review mentioned above suggests that diet shapes gut bacterial composition, with macronutrients influencing gut microbiota populations.

Researchers highlight the following foods as supporting a healthy microbiota:

This was in contrast to excessive consumption of animal protein, saturated fat, and refined or artificial sugars.

In addition, the study suggests that following high-quality diets, such as the Mediterranean diet, reduces the risk of depression.

The Mediterranean diet has anti-inflammatory benefits (inflammation is a risk factor for anxiety and depression), is low in saturated fat, and high in dietary fiber, further enhancing its role in maintaining a healthy microbiota.

Learn more about the Mediterranean diet here.

A person should talk to a health or mental health professional if they are experiencing symptoms of an anxiety disorder. They can advise a person about treatment options and refer them to the support they need.

Likewise, people should seek medical advice if they experience persistent digestive problems. A healthcare team will be able to determine any underlying problems that may be causing them, including whether they are related to an anxiety disorder.

It may also be worth talking to a qualified nutritionist about how to improve your diet and how to increase your probiotic intake.

Gut health and anxiety disorders are common health problems in the United States. Researchers investigating the relationship between these conditions have focused on the “gut-brain axis,” a complex system of nerves, hormones, and bacteria that allows these two organs to communicate.

Research shows that stress can change the composition of the gut microbiota, a system of microorganisms in the gastrointestinal tract that plays an important role in human health. A person’s gut microbiota is also involved in the development and functioning of their adaptive stress response.

Adding probiotics to a person’s diet can help regulate gut microbiota, which can also help improve symptoms of stress and anxiety. Following a healthy diet can further support a healthy gut microbiota composition and reduce the risk of depression.

People experiencing symptoms of anxiety or digestive problems should speak to a health professional who will be able to advise them on treatment options.

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