A recent study found that those who helped clean up after the events of 9/11 had double the incidence of Acid Reflux (GERD) and other gastrointestinal diseases, than the general population four to five years after the event.

The expression “stop bellyaching” tells a lot about how stress affects the body. For many people, when problems attack, so does a stomach ache. Certainly it’s no surprise that tension messes up the gut, but the degree to which it creates serious gastrointestinal issues might surprise you.

A recent study out of Stony Brook University Medical Center in New York evaluated 697 patients who had helped clean up after the events of 9/11. Four to five years after the cleanup, 41% had gastroesophageal reflux disease (GERD), compared with about 20% of the general population. GERD occurs when stomach acid or bile backs up into the esophagus, causing chronic heartburn and acid reflux. It’s an uncomfortable condition at best; debilitating at its worst, sometimes driving victims to surgery.

It’s noteworthy that even without an obvious triggering trauma, one out of every five adults in the general population has the disease. That’s a huge percentage, but not surprising given that obesity often links to GERD and so many people count among the obese. It’s also relevant that exposure to acute trauma such as that experienced by people cleaning up human remains at the World Trade Center site not only doubled the incidence of GERD, but also caused gastrointestinal symptoms that persisted for years (and that still persist, the research shows).

The researchers found that length of time at the cleanup site correlated with risk of GERD — the longer the exposure to the site, the greater the likelihood that the person developed gastrointestinal disease. No correlation was found to obesity among the cleanup workers. The researchers attribute this phenomenon to stress — not to environmental toxins.

Not surprisingly, many of the 9/11 cleanup workers suffer from continuing psychological problems, and the researchers found that such problems correlate to GERD. Five years after the cleanup, 21% of those with GERD had post-traumatic stress disorder (PTSD), 21.5% were clinically depressed, and nearly 30% had anxiety disorder. Two years later (seven years after the trauma), the numbers of those with both GERD and mental health problems actually went up. By 2008, almost 33 percent of the GERD sufferers reported depression. In fact, having several mental health disorders — for instance, both anxiety and depression — made the risk of GERD among the 9/11 workers almost inescapable. Among those with both depression and anxiety, 64 percent had GERD. Add PTSD into the mix, and that rate goes up to almost 70 percent.

It seems counterintuitive that as the years since 9/11 have passed and the traumatic events have become more distant, those originally exposed to the trauma have experienced an increase rather than a decrease in associated gastrointestinal and mental health symptoms. So much for the “time heals all wounds” theory. The explanation might be that untreated grief and trauma don’t disappear with time, but rather, simmer beneath the surface, creating a snowball effect. In any event, the researchers suggest that treating mental health issues may be key to resolving the gastrointestinal health issues.

As Dr. Douglas Brand, one of the researchers involved in analyzing the study data, says, “Eight years after 9/11 we are still realizing the aftereffects on those who responded and participated in the massive cleanup efforts. Shortly after this highly stressful and toxic exposure, the appearance of GERD characterized by high comorbidity [the addition of one or more disorders in addition to the GERD] with mental health disorders, but no relation to obesity or smoking, suggests that mental health disorders may play an important role in the persistence of GERD among these workers. Thus, treatment of the underlying mental health disorder may be necessary to resolve the physical manifestation of GERD.”

Hopefully the experts will take to heart evidence that counseling needs to be given to those exposed to trauma at the time of the exposure — even if the victims of that exposure seem functional — rather than letting trauma reactions (and concomitant physical symptoms) develop over the ensuing years.

Meanwhile, a simultaneous study found another reason that high-stress environments induce bellyaches. Dr. Mark Riddle of the Naval Medical Research Center in Bethesda, Maryland, studied the impact of infectious gastroenteritis among military personnel on the subsequent development of long-term gastrointestinal diseases including irritable bowel syndrome. Infectious gastroenteritis includes such conditions as diarrhea and dysentery, commonly contracted by people traveling and living in stressful situations.

When we deploy overseas, one of the biggest risks is infectious gastrointestinal disorders,” Dr. Riddle said. “By six months, troops will usually have one or more episodes of infectious gastroenteritis.” Doctors typically prescribe antibiotics to wipe out the causative bacteria and end the acute episode, but this study found that once infected, the victim may suffer far-reaching and long-lasting consequences far beyond the run-of-the-mill dysentery bout. Those who had experienced even one incident of infectious gastroenteritis were at six times the risk for subsequent functional diarrhea, and at four times the risk for irritable bowel syndrome.

The researchers point to the continued stress that troops remain subject to as a triggering factor in developing gastrointestinal diseases once a vulnerability has been established through prior infection. Dr. Riddle also notes that the vulnerability may be related to changes in “gut microbiota or neural symptoms related to the gastrointestinal tract.”

In other words, though the antibiotics may take care of the infection, something is messing up the gut bacteria. Reading between the lines, it looks like all fingers point to the antibiotics doing long-term damage, stress or no stress. (Once again, as I always point out, after exposure to antibiotics, you need to supplement with a good probiotic formula to rebuild populations of beneficial bacteria.)

Considering the vulnerability of the gastrointestinal system to stressors both environmental and psychological, we can only hope that the experts get smart and start distributing mental health care to those exposed to trauma, as well as supplements that replenish gut flora and education about how to protect and revitalize the bowels. And as for GERD/Acid Reflux, you might want to read up on exactly how it manifests in your intestinal tract and the various natural health approaches you can use to overcome it. I’ve covered this extensively, in my newsletter series on the intestinal tract, but if you just want to cut to the chase and jump right in, you can start with Your Stomach, Part 3.

:hc