Why Your Anxiety Lives in Your Stomach: Understanding the Gut-Brain Connection
A holistic therapist's guide to the powerful connection between digestive health and anxiety—and what you can do about it.
If you struggle with gastrointestinal distress—nausea, stomach pain, IBS symptoms, cramping, or that constant feeling of "butterflies"—and you've wondered if it's connected to your anxiety, you're absolutely right to make that connection.
As a licensed therapist specializing in holistic anxiety therapy at Cedar Rose Counseling & Wellness in West Chester, Ohio, I work with anxious women every day. And aside from anxiety itself, one of the most common symptoms I see is digestive distress.
So can GI issues be connected to anxiety? Absolutely. Your gut and brain are in constant communication. And when one is struggling, the other feels it too.
In this article, we're going to explore:
Why anxiety affects your digestive system so profoundly
The gut-brain axis and vagus nerve
How this connection works in BOTH directions
Why holistic therapy approaches this differently than traditional treatment
Practical nervous system regulation techniques you can use today
Important note: I'm a licensed therapist, not a registered dietitian. This article isn't about telling you to take probiotics or eat more fiber—though those interventions can certainly be helpful. For specific dietary guidance, I recommend working with a registered dietitian who specializes in gut health. See our recommendations for local Holistic Practitioners in Cincinnati, OH.
This article is about understanding what's actually happening in your body so you can address anxiety at its root and finally get relief from the physical symptoms that have been disrupting your life.
Why Does Anxiety Affect Your Gut?
Let's start with the fundamental question: Why does anxiety show up in your stomach?
If you've read my previous article on the nervous system and anxiety, you'll remember that when your brain or body detects a threat—real or perceived—your sympathetic nervous system activates. This is your fight-or-flight response, your survival mode.
And when your body goes into survival mode, digestion gets paused.
Your body isn't worried about breaking down lunch when it thinks you're in danger. It's focused entirely on keeping you alive and safe from the perceived threat.
What Happens Physically in Your Digestive System During Anxiety
Here's what occurs in your gastrointestinal system when your body feels unsafe:
Blood flow gets redirected away from your digestive organs and toward your major muscle groups—your legs and arms—so you can fight or flee from danger.
Gut motility changes. Motility refers to the movement of your digestive tract—the contractions that move food through your system. When you're anxious, this either speeds up dramatically (leading to diarrhea) or slows way down (causing constipation). Sometimes it does both, which is why so many people with anxiety also experience IBS—Irritable Bowel Syndrome.
Stomach acid production changes. Sometimes it increases, leading to acid reflux or heartburn. Other times it decreases, making digestion more difficult and less efficient.
Your entire gut environment shifts. The balance of bacteria in your gut (your microbiome), the way nutrients are absorbed, even the integrity of your intestinal lining—all of it is affected by stress and anxiety.
Common Gut Symptoms of Anxiety
With all of these physiological changes, the common digestive symptoms of anxiety include:
Nausea
Stomach pain or cramping
Diarrhea, constipation, or alternating between both
Loss of appetite—or stress eating
Bloating and gas
Acid reflux or heartburn
That general feeling of your stomach being in knots or having "butterflies"
Your anxiety and your digestive symptoms are interconnected through something called the gut-brain axis. These are not separate issues.
And that's actually good news. Because it means when we address one system, we can improve the other. You don't have to fix your anxiety first and THEN deal with your stomach issues, or vice versa. You can work on both simultaneously because they're part of the same integrated system.
The Gut-Brain Axis Explained
So what exactly IS the gut-brain axis?
The gut-brain axis is the constant two-way communication system between your gut and your brain. They're sending signals back and forth to each other continuously, all day, every day, throughout your entire life.
This communication happens through multiple pathways:
Physical connection: Primarily through the vagus nerve, which we'll discuss in detail shortly.
Chemical messengers: Hormones, neurotransmitters, and immune system signals that travel between your gut and brain, influencing both digestive function and mental state.
Your Gut Has Its Own Nervous System
Here's something that surprises most people: Your gut actually has its own nervous system, separate from your brain and spinal cord.
It's called the enteric nervous system (ENS), and it contains over 100 million nerve cells lining your gastrointestinal tract.
This is why your gut is sometimes called your "second brain." It can operate independently of your actual brain in many ways, controlling digestion, nutrient absorption, and even producing neurotransmitters that affect your mood and mental state.
The Vagus Nerve: Your Gut-Brain Superhighway
Let's talk specifically about the vagus nerve, because this is a key player in the gut-brain connection that you'll hear mentioned frequently in discussions of holistic health.
The vagus nerve is the longest nerve in your body. It runs from your brain stem all the way down through your body, connecting to your heart, lungs, and digestive organs.
What makes the vagus nerve so powerful—and why it's discussed so extensively in anxiety and gut health contexts—is that it sends signals in BOTH directions.
The vagus nerve allows:
Your brain to communicate TO your gut ("We're stressed; shut down digestion")
Your gut to communicate TO your brain ("There's inflammation down here; create an anxiety response")
This is why you can literally "feel" emotions in your stomach. When you say you have "butterflies" when you're nervous, or you feel "gut-wrenching" sadness, or something doesn't "sit well" with you—those aren't just metaphors or figures of speech.
You're actually experiencing the physical manifestation of your gut-brain communication.
The Bidirectional Relationship Most People Miss
So yes, Anxiety can certainly lead to GI distress. But what's equally true—and often overlooked—is that stomach problems can actually cause or worsen anxiety.
It's a two-way street because of this gut-brain connection.
If your gut is inflamed, if your microbiome is out of balance, if you're dealing with chronic digestive issues—your gut is sending distress signals to your brain through the vagus nerve. And your brain interprets those signals as: "Something's wrong. We're not safe. We need to activate our protective response."
So you might feel anxious and not even know why there's no obvious external trigger. But your gut knows. Your gut is telling your brain that something's off, and your brain is responding with an anxiety response to protect you.
This is why addressing gut health can actually improve anxiety symptoms. And it's why addressing anxiety can improve digestive issues. They're not separate problems requiring entirely separate solutions. They're interconnected aspects of one system.
Your Gut's Critical Role in Mental Health
Now that we understand the gut and brain are in constant communication, let's go deeper into how your gut specifically impacts your mental health and anxiety levels.
Neurotransmitter Production Happens in Your Gut
Here's a statistic that genuinely surprises most people, including many healthcare providers:
About 90% of your serotonin is produced in your gut—not in your brain.
Serotonin is one of your primary mood-regulating neurotransmitters. It affects:
Your mood and emotional stability
Your anxiety levels
Your sleep quality
Your appetite and eating patterns
Many other aspects of mental health
And the vast majority of this crucial neurotransmitter is being manufactured by the cells lining your intestinal tract, not by your brain.
Your gut bacteria—your microbiome—also produce other neurotransmitters and mood-regulating chemicals like:
GABA (your primary calming neurotransmitter)
Dopamine (involved in motivation and pleasure)
Various chemicals that influence cortisol (your stress hormone)
So when your gut health is compromised—when you have inflammation, when your microbiome is out of balance, when digestion isn't working properly—neurotransmitter production suffers. And this directly impacts your anxiety, your mood, your stress resilience, and your sleep quality.
If you've been struggling to manage your mood and traditional mental health approaches haven't been as helpful as you'd hoped, taking a closer look at your gut health could be a valuable next step.
The Microbiome Connection
Let's talk about your microbiome for a moment. You have trillions—literally trillions—of bacteria living in your gut. Collectively, they're called your microbiome.
And they're not just passive inhabitants taking up space. They're actively influencing your health in profound ways.
These bacteria in your gut influence:
Inflammation levels throughout your entire body
Immune system function
Nutrient absorption and vitamin production
Brain chemistry and neurotransmitter production
Mood regulation and mental health
Research has shown that people with anxiety disorders (and other mental health conditions) often have different gut bacteria profiles compared to people without these conditions. Specifically:
Their microbiome diversity is often lower
They tend to have higher levels of inflammatory bacteria
They often have fewer beneficial bacteria that produce calming neurotransmitters
And here's where it gets even more interesting: Chronic stress and anxiety actually change your microbiome composition.
When you're chronically stressed or anxious, it alters the balance of bacteria in your gut:
Beneficial bacteria decrease
Harmful or inflammatory bacteria can increase
Overall diversity goes down
And then that changed microbiome sends signals back to your brain through the vagus nerve—signals that increase inflammation and worsen anxiety.
The Vicious Cycle of Anxiety and Digestive Distress
Can you see how this becomes a vicious, self-perpetuating cycle?
You feel anxious, which triggers digestive symptoms through your sympathetic nervous system activation
Those digestive symptoms are uncomfortable, embarrassing, and disruptive to your daily life
Now you're anxious ABOUT the symptoms themselves—"What if I have to run to the bathroom in the middle of the meeting?" "What if my stomach starts making noises during the presentation?" "What if I feel nauseous on my date?"
That additional anxiety makes the digestive symptoms worse, because you've further activated your sympathetic nervous system
Worse symptoms create even more anxiety, and the cycle continues to compound
This is one of the most common patterns I see in my holistic anxiety therapy practice at Cedar Rose. Women come to me feeling completely trapped in this cycle, not knowing how to break out of it, exhausted from years of struggle.
And this is precisely why traditional approaches that only focus on your thoughts—or only focus on your gut symptoms through medication or diet alone—often fall short. Because you're not addressing the whole interconnected system that's creating and maintaining the problem.
Why Traditional Treatment Often Misses the Gut-Brain Connection
If the gut-brain connection is so important and so well-established in research, why isn't everyone in healthcare talking about it? Why do so many people struggle for years—even decades—without anyone connecting the dots between their anxiety and their digestive issues?
The problem, as I see it, is compartmentalization in healthcare.
And I want to be clear: I think this compartmentalization began with the best of intentions. It makes complete sense that healthcare providers have specialties and develop deep expertise in specific areas. There's an overwhelming abundance of medical information, and it's impossible for any one person to stay current on everything unless they narrow their focus.
Compartmentalization and specialization aren't inherently problems. The lack of collaboration and communication between specialists is the problem.
How Compartmentalization Fails Patients
Here's what typically happens:
You go to a gastroenterologist or dietitian for your digestive issues. They might diagnose you with IBS, prescribe medication to manage symptoms, recommend dietary changes. But they're focused primarily on the physical, digestive symptoms in isolation from your mental health.
You go to a therapist or psychiatrist for your anxiety. They might teach you cognitive behavioral techniques, prescribe anti-anxiety medication, recommend stress management practices like deep breathing. But they're focused primarily on your mental and emotional symptoms in isolation from your physical health.
But these aren't separate problems that just happen to coexist by coincidence. They're two aspects of the same dysregulated system.
What I See in My Practice
In my practice at Cedar Rose, I regularly see women who have been to multiple doctors for their digestive issues and multiple therapists for their anxiety—but no one has ever connected the dots for them.
They're being treated for two supposedly separate problems when it's actually one interconnected system that needs integrated support.
And honestly, this integrated, holistic approach is how I came to specialize in anxiety therapy in the first place.
I had a personal experience where I changed one thing in my diet, and that single change led to:
Complete elimination of chronic GI distress I'd been experiencing
A drastic decrease in depression and anxiety symptoms
A fairly profound increase in energy levels
I had no idea I'd been experiencing dysregulation in my gut. I had completely normalized and simply dealt with uncomfortable symptoms for years without realizing they could be addressed.
But from that experience, I learned just how interconnected the body truly is. And I realized that if we're trying to truly help people heal—not just manage symptoms temporarily—we need to address the whole system, not just one isolated piece of it.
A Holistic Approach to Gut-Brain Healing
So what does a holistic approach to gut-brain healing actually look like in practice?
At Cedar Rose, we begin with a thorough assessment and a discussion about who might be beneficial to include in your whole-care team.
For significant GI distress, I refer clients to registered dietitians and functional diagnostic nutrition practitioners who have expertise in gut health and who can:
Run appropriate lab tests to assess gut function
Recommend targeted supplements if needed
Guide specific dietary changes based on your unique situation
Monitor your progress and adjust interventions as needed
On the therapy side, I bring together nervous system regulation, evidence-based therapeutic approaches, and mind-body connection work. Because lasting healing requires all three components working together.
Acceptance and Commitment Therapy (ACT) for Gut-Brain Issues
The primary therapeutic approach I use is Acceptance and Commitment Therapy (ACT). And ACT is particularly effective for gut-brain issues because it helps you fundamentally change your relationship with both your anxiety and your physical symptoms.
Let me break down how ACT applies specifically to gut-brain healing:
1. Acceptance
First, acceptance. This doesn't mean giving up or resigning yourself to suffering forever. It means stopping the fight against your symptoms and the secondary anxiety they create.
When you have a digestive flare-up, what's your first reaction? For most people, it's panic, frustration, catastrophizing—"Why is this happening again? What if it gets worse? I can't deal with this. I'm going to have to leave work early."
That resistance and panic actually make the symptoms worse. Your nervous system gets more activated, which further disrupts digestion, which creates more intense symptoms, which creates more panic. The cycle perpetuates itself.
Acceptance means acknowledging: "Okay, I'm experiencing discomfort right now. My stomach hurts. I feel anxious about it. And I can make space for this without catastrophizing or making it bigger than it is."
When you stop fighting the symptoms and the anxiety about the symptoms, you reduce that secondary layer of suffering. And often, the physical symptoms themselves begin to ease because your nervous system can start to calm down.
2. Cognitive Defusion
Second, defusion. This is about noticing your anxious thoughts about your gut health without believing all of them or letting them dictate your behavior.
Anxious thoughts about digestive symptoms are usually catastrophic and predictive:
"What if I have to run to the bathroom during the meeting?"
"What if my stomach starts hurting and I can't leave?"
"What if people notice and judge me?"
"This is never going to get better."
"There must be something seriously wrong with me."
Defusion helps you recognize: these are thoughts, not facts. These are predictions your anxious brain is making to try to keep you safe, not certainties about what will actually happen.
You can notice the thought—"There's my brain predicting bathroom emergencies again"—without letting it control your choices or spiral into panic.
3. Present Moment Awareness
Present moment awareness is grounded in mindfulness. This means staying connected to what's actually happening right now in your body, rather than projecting into the future or ruminating about the past.
Anxiety about gut symptoms is almost always future-focused: "What if this happens during my presentation? What if that happens on my date?"
Mindfulness brings you back to right now: "Right now, in this moment, I'm okay. My stomach feels a little uncomfortable, but I'm safe. I'm breathing. I can handle this present moment."
This present-moment grounding activates your parasympathetic nervous system—your rest-and-digest mode—which is the foundation of what your gut needs to function properly.
4. Values Clarification
Fourth, identifying your values. What actually matters to you in life? Connection? Growth? Health? Creativity? Adventure? Contribution?
When anxiety and gut symptoms are running the show, you start making decisions based on fear rather than on what you truly value.
You skip the social event because your stomach might act up. You avoid trying new foods because they might trigger symptoms. You turn down professional opportunities because "what if I need a bathroom?"
Your life becomes smaller and smaller as you try to control and avoid potential symptoms.
ACT helps you clarify: What do I actually value? And am I willing to carry some discomfort in service of those values?
This doesn't mean ignoring your body's genuine needs or pushing through serious symptoms. It means not letting fear and anxiety make all your decisions for you.
5. Committed Action
And fifth, committed action. This means taking action aligned with your values even when anxiety and physical symptoms are present.
You might feel anxious about your stomach at the social event. And you go anyway, because connection and relationships matter to you.
You might experience some digestive discomfort trying a new food. And you try it anyway, because nourishment, variety, and enjoyment of food matter to you.
Over time, as you take these values-aligned actions despite the presence of symptoms, you build evidence for yourself: "I can handle this. The symptoms might be uncomfortable, but they don't control my entire life."
And here's what's paradoxical and beautiful: as you stop avoiding everything because of fear of symptoms, the symptoms often begin to decrease. Because your nervous system learns through experience: "We're actually safe. We can relax. We don't need to stay on high alert constantly."
Mindfulness Practices as Foundation
Throughout all of this ACT work, mindfulness practices are essential. These include:
Body scan meditations that help you tune into gut-brain signals with curiosity rather than judgment
Breathwork practices that specifically activate the vagus nerve and calm the digestive system
Non-judgmental observation of physical sensations—noticing tension, discomfort, or calm without immediately adding a catastrophic story to the sensation
These practices aren't just nice additions to therapy. They're foundational to retraining your nervous system, rewiring your brain and improving the quality of gut-brain communication.
Nervous System Regulation Techniques for Gut-Brain Healing
Now let's talk about specific, practical nervous system regulation techniques you can start using today. Because this is where the real, tangible healing happens.
You cannot calm your gut without calming your nervous system. They're inextricably connected. If your nervous system is in a chronic state of activation—stuck in fight-or-flight mode—your digestion will continue to be disrupted no matter what supplements you take or foods you avoid.
The key is vagus nerve stimulation and creating regular opportunities for parasympathetic nervous system engagement (your rest-and-digest state).
1. Vagus Nerve Stimulation Through Breathwork
Your vagus nerve is the primary communication highway between your brain and gut. When you stimulate and tone this nerve regularly, you're literally improving the quality of bidirectional communication between these two systems.
The two strategies I teach most often for vagus nerve activation are:
Box Breathing: Inhale for 4 counts, hold for 4 counts, exhale for 4 counts, hold for 4 counts. Repeat for 5-10 minutes.
Elongated Exhale Breathing: Inhale for 4 counts, exhale for 6-8 counts. The extended exhale specifically activates the vagus nerve and signals safety to your nervous system.
I have guided practices for both of these techniques available on my Mindful Moments YouTube channel and Spotify.
2. Gentle Movement
Movement helps gut-brain healing in multiple, interconnected ways:
Releases physical tension that accumulates in your abdomen and throughout your body
Stimulates healthy gut motility (the natural movement of your digestive tract)
Discharges excess stress and nervous system activation
Brings you into your body and out of anxious, ruminating thoughts
Particularly helpful forms of gentle movement include:
Gentle yoga, especially poses that involve twists (which massage digestive organs) and forward folds (which activate the parasympathetic nervous system)
Walking, especially after meals to support healthy digestion
Stretching to release tension in your abdomen, hips, and lower back
Dancing in your kitchen while you make dinner, or any form of free, joyful movement to discharge stress
The key is finding movement that feels good and sustainable for you, not forcing yourself into an exercise routine that feels punishing.
3. Grounding Practices
When you're anxious about your gut symptoms, you're usually in your head, catastrophizing about what might happen. Grounding practices bring you back into your body and the present moment, where you can actually respond effectively.
Grounding can happen in a variety of ways. Some of my favorites include:
5-4-3-2-1 technique: Name 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell, 1 you can taste. This brings you immediately into sensory, present-moment awareness.
Progressive muscle relaxation: Systematically tense and release muscle groups throughout your body, releasing accumulated physical tension.
Guided body scan meditations: I have several of these available on my Mindful Moments channel specifically designed for anxiety and digestive distress.
Creating a Sustainable Practice
When you practice these regulation techniques regularly—not just when you're in crisis or experiencing severe symptoms—you're retraining your nervous system over time.
You're widening your window of tolerance. You're teaching your body what safety actually feels like. And your gut responds positively to that increased sense of safety and regulation.
If you're a planner and you'd like something physical to reference as you think about practicing these regularly, I encourage you to grab my free Calm Guide. The guide provides 5 key strategies for managing and healing anxiety, and it walks you through the process of scheduling them into your week using a concept called relaxation training.
The nervous system regulation strategies we just discussed would be excellent additions to your personalized schedule. And this doesn't need to become an overwhelming task. Just pick 1-2 techniques to try each day. Attach them to an already established routine (like your morning coffee or your evening wind-down), and notice how your body starts to respond over time.
Moving Toward Integrated Healing
Let's bring everything together with some key takeaways:
First: Your anxiety and gut symptoms are connected through the gut-brain axis. The vagus nerve serves as the primary communication highway between these two systems, sending signals constantly in both directions.
Second: This connection is bidirectional. Your brain affects your gut, absolutely. But your gut also profoundly affects your brain. Gut inflammation, microbiome imbalance, and digestive distress send signals to your brain that can create or significantly worsen anxiety.
Third: About 90% of your serotonin—your primary mood-regulating neurotransmitter—is produced in your gut, not your brain. This means gut health IS mental health. They're not separate domains.
Fourth: You can't think your way out of gut-brain dysregulation. Cognitive techniques alone are usually insufficient. Nervous system regulation and addressing the physical components are essential for lasting healing.
Fifth: Holistic approaches that address your nervous system, your psychological patterns, AND your physical symptoms together are the most effective for creating real, sustainable change.
You're Not Broken
If you've been struggling with both anxiety and digestive issues—maybe for months, maybe for years, maybe for as long as you can remember—I want you to hear this clearly:
You're not broken. Your body isn't failing you.
Your body is doing exactly what interconnected systems do—communicating with each other, responding to stress and perceived threats, trying to protect you from harm.
And when we understand that connection, when we work WITH your body's protective mechanisms instead of fighting against them, real healing becomes possible.
You don't have to stay trapped in the anxiety-digestive symptom cycle. There is a path forward that addresses the root causes rather than just managing surface-level symptoms. And it starts with understanding what's actually happening in your integrated mind-body system.
Ready for Deeper Support?
If you're in Ohio and you're ready for professional support that addresses both your anxiety and your physical symptoms in an integrated, holistic way, I'd love to work with you.
At Cedar Rose Counseling & Wellness, I specialize in holistic anxiety therapy for women. We use a combination of nervous system regulation, Acceptance & Commitment Therapy (ACT), mindfulness practices, and collaborative care with other providers (like dietitians) to create comprehensive, whole-person healing.
I offer both in-person sessions at my West Chester office and telehealth appointments throughout Ohio.
If you're not in Ohio, I also offer a self-paced course that provides the educational foundation of anxiety therapy. In the course, you'll gain:
An accurate understanding of anxiety and the mind-body connection
Skills to identify and manage your unique triggers
Evidence-based strategies to practice both proactively and in moments of acute stress
Clear guidance on the how, when, and why of using various regulation techniques
You can find more information about the course in the resources section below.
Free Resources
Download the Calm Guide: Get 5 proven nervous system regulation strategies and a step-by-step action plan for implementing relaxation training in your daily life. Download here
Guided Meditations: Access free practices for vagus nerve activation, body scans, and nervous system regulation on the Mindful Moments YouTube channel and Spotify.
Related Article: "Why Anxiety Feels Physical: Understanding Your Nervous System" - Dive deeper into how your nervous system creates anxiety symptoms. Read here
Thank you for taking the time to understand your gut-brain connection. I hope this article has helped you make sense of what's been happening in your body and has given you genuine hope that healing is possible.
You deserve integrated, comprehensive support for both your mental and physical health. And you don't have to figure this out alone.
Take good care.
Katie McLaughlin, LPCC-S, is a licensed therapist and the founder of Cedar Rose Counseling & Wellness in West Chester, Ohio. She specializes in holistic anxiety therapy for women, using Acceptance & Commitment Therapy (ACT), nervous system education, and mind-body integration to help clients heal anxiety at the root. Katie is passionate about helping women understand the gut-brain connection and its impact on both mental and physical health.
