Aaron Swartz And The Brain-Gut Connection

Two health-related points struck me in this disturbing but exceedingly smart piece in the current New Yorker about the “darker side” of Aaron Swartz, the gifted young Internet activist who hanged himself in his Brooklyn apartment in January. (The “dark” health aspects of the story were so powerful that I called an expert to find out more about the potent connection between disorders of the gut and the brain. See below.)

First, the depth of Swartz’ physical distress and heightened sensitivity to everything from food to music is astounding. Reporter Larissa MacFarquhar writes:

He disliked all vegetables and refused to eat them except in extremely expensive restaurants, such as Thomas Keller restaurants. He had ulcerative colitis, a serious digestive disorder similar to Crohn’s disease; he also thought that he was a “supertaster,” experiencing sensations of taste more intensely than regular people. Partly for these reasons, he ate only foods that were white or yellow. He ate pasta, tofu, cheese, bread, rice, eggs, and cheese pizza. He was phobic about fruit and wouldn’t touch it. He rarely drank alcohol and was careful to stay hydrated. He went through four humidifiers in his apartment in Brooklyn. He said that he left San Francisco because the air-conditioning was bad. He was a supertaster in matters other than food: things always seemed much better or worse to him than they did to other people.

[From Swartz' own writing]: I recently had to sit through a performance of Bach’s Well-Tempered Clavier at the Chicago Symphony Orchestra. . . . At first it was simply boring, but as I listened more carefully, it grew increasingly painful, until it became excruciatingly so. I literally began tearing my hair out and trying to cut my skin with my nails (there were large red marks when the performance was finally over). (2006)

The second issue that seemed particularly relevant to the entire tragedy is the severity of Swartz’ ulcerative colitis, a type of inflammatory bowel disease that affects the colon and rectum, with symptoms that can range from highly uncomfortable to seriously painful. In the piece, MacFarquhar quotes one of Swartz’ friends discussing the link between ulcerative colitis, depression and suicide:

NIH/wikimedia commons

NIH/wikimedia commons

A doctor relative last night told me that he’d had some very painful experiences with patients with ulcerative colitis committing suicide. Apparently co-morbidity with depression is common. I’ve been thinking about it a lot for the last twelve hours. I know during the scare in 2007 he had gotten very, very sick from his U.C. He definitely didn’t seem depressed right before his death, nor for a long time previously. He wasn’t doing normal depressed-people things (like withdrawing from friends and family), let alone suicidal-people things (like giving away his stuff). However, he did commit suicide, which weighs pretty heavily on the other side of the scale. My doctor relative told me that some of his ulcerative-colitis patients seemed to be doing much better until the moment when they suddenly committed suicide, and that there’s some speculation that U.C. can alter liver functioning, which in turn can cause other medicine to cause impulsive behavior like suicide.
Ben Wikler, a friend

I spoke with Suzanne Bender, a psychiatrist at Massachusetts General Hospital and the psychiatric liaison to the pediatric gastro-intestinal service at MGH. Every Thursday, Dr. Bender sees children and adolescents with GI problems that have not responded to typical treatments, and have also caused emotional distress. She says many of these patients only get relief from their GI symptoms once coordinated care is provided, between GI and Psychiatry.

“In general, the gut and the brain talk to each other quite a bit,” Bender said. “There is a neural feedback from the gut to the brain so chronic gastrointestinal distress can exacerbate anxiety or depression.”

It also works the other way around: “Once you have anxiety or depression it can actually aggravate the gut,” she said. “When a person is nervous or upset, gastrointestinal distress or diarrhea may follow. Before an event that is anxiety-provoking (flying, taking a test, or competing in any event) a person may experience significant GI discomfort.”

(She made the point that there’s absolutely no evidence that ulcerative colitis is caused by depression or any other mental illness, and of course, she can’t comment on Swartz’ case specifically.)

But, Bender said, while anyone with a chronic medical illness may be at higher risk for mental distress, “there is a basic feeling that gastrointestinal and emotional distress are uniquely linked.”

“We know that stress can aggravate the gut in normal people,” she said, “In a person with inflammatory bowel disease such as ulcerative colitis or Crohn’s who is already suffering, we want to be aggressive in treating any mental health issue that they have.” She added: “I have a lower threshold for more aggressive psychiatric treatment because I want these patients to be as resilient as possible ”

Bender sent me a 2012 study published in the medical journal Gut which concluded that for “functional gastrointestinal disorders” like IBS, reflux, constipation, the “brain-gut pathway is bidirectional.”

What does that mean? Bender boils down the prospective study, which followed up with more than 1,000 people after 12 years, this way:

“People with anxiety but without GI symptoms were more likely to have new symptoms of a [functional GI disorder] FGID 12 years later. So anxiety increased the chance of GI distress later on. For people with FGID at baseline, anxiety and depression scores were increased 12 years later i.e. ongoing GI distress increased the chance of anxiety and depression in the future.”

The basic idea, she says, is that your central nervous system and your gut are a two-way street. “People sometimes think of their body starting from the shoulders down…I like to remind them that they have a neck.”

We will never know the impact of Swartz’ GI problems on his mental fragility or vice versa.

But knowing that your gut and brain have a special symbiotic connection when it comes to health might make you — and the people around you — listen to the distress signs of both a little closer.

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  • KnowUC

    I’ve suffered with UC for 20+ years. The only medication that keeps my symptoms under control, and puts the disease into courses of remission, is Effexor–an SSRI medication prescribed for depression. I started the drug following my mother’s death when I was situationally depressed and needed support. The medication calmed my gut along with my emotions and my GI doc agreed it was a good alternative if my UC symptoms continued to stay under control. The downside of the drug is significant weight gain, but the weight sure beats the many disruptions of daily living that come with UC when it’s in an active stage.

  • Suzanne Bender, MD

    The parent of a young man with ulcerative colitis makes an important clarification that Inflammatory Bowel Disease (IBD) is a very different and more serious gastrointestinal disorder than the more common functional GI disorders such as Irritable Bowel Syndrome (IBS). That said, the point of the article quoted is that GI distress, even of a more minor nature, can cause or exacerbate emotional distress.

  • http://www.facebook.com/bkort Barry Kort

    By the way, our language has many terms suggesting that stress is felt in the gut.

    Consider terms like livid, galled, splenetic, dyspeptic, pissed, and bilious. Each of these is reference to a gut organ or a gut secretion. And then there is nausea and disgust.

  • IBDMom

    As the parent of a young man who has lived with ulcerative colitis from early teenage years, I was saddened to read this news. I have to admit when I read of Swartz’ suicide and heard reminiscences describing him as “painfully thin”, UC was the first thing I thought of. So sorry to have been correct.

    I am, however, puzzled that Dr Bender sent you an article about IBS and other functional gastrointestinal disorders when UC is in a different category — inflammatory bowel disease. The International Association for Functional Gastrointestinal Disorders quite clearly defines inflammatory bowel disease as NOT an FGID: “These will have uniquely identifying features which differentiate them from functional GI or motility disorders.” http://www.iffgd.org/site/gi-disorders/other/ IBS and IBD are so frequently confused with each other that the Crohn’s and Colitis Foundation of America has a web page about the confusion, here: http://www.ccfa.org/resources/ibs-and-ibd-two-very.html I appreciate Dr. Bender’s making clear that the IBDs are not *caused* by stress, but in passing on the *Gut* study she might have introduced some additional confusion for IBS and IBD patients and their families, since the *Gut* study had nothing to do with what Swartz was diagnosed with.

  • http://www.facebook.com/bkort Barry Kort

    I can confirm that even commonplace encounters with the legal system can cause debilitating gastro-intestinal distress, migraine headaches, and long-lasting clinical depression.

    The entire US legal system (including criminal, civil, and family court divisions) is routinely used in an outrageously abusive manner.

    Those who are traumatized, stigmatized, or victimized by such shenanigans within the legal system may suffer what has come to be called Legal Abuse Syndrome.