Reader, there are phrases in the English language that, when spoken, invoke a universal human reaction… and one of them is most certainly, “I think I’m going to be sick.” Sometimes, those words are spoken after a big meal, or during a particularly long and winding car journey. Other times, they’re spoken in response to an emotional stimulus—right after a breakup of a friendship or love relationship, for instance, or before a job interview. And as a psychiatrist, it’s these latter instances I’m most curious about. Why is it that a sudden pang of stress is so often followed by a sudden feeling of illness? What are the physiological and psychological connections between facing an emotional moment and your gut turning itself in knots? When we are in emotional or physical pain, our bodies respond with a spectrum of chain reactions, from subtle (think tears welling up in the eyes) to aggressively obvious (think inflammation from a particularly bad bee sting), designed to protect us—but there can be such a thing as too much, or too little, of a good thing, and that holds especially true when it comes to the protective mechanisms of our bodies. This week, I want to discuss how your genes might be predisposing you to gut dysbiosis—and those “I think I’m gonna be sick” reactions—and what you can do to bring your body back into balance!

Your Orchid Genes, Revisited

Earlier this year, we discussed how our genes can predispose us towards being an “orchid” or being a “dandelion.” Like the flower for which they’re named, orchid individuals are more vulnerable to chronic stress situations and need specific ambient conditions to thrive. They are much more “culture-dependent” than dandelions and do much better in emotionally warmer, personal-growth-oriented, nurturing environments. Dandelions, on the other hand, are genetically equipped to be more adaptable to many different environments—in other words, they can “grow anywhere”. But they will never be an orchid. The difference between the two lies in how specific genetic variants affect the body’s HPA axis, which in turn dictates our “fight, flight, or freeze” response to stress. Here’s a helpful refresher: the body’s response to stress begins in a part of the brain known as the Amygdala. Located deep in the brain’s temporal lobe, the Amygdala scans our environment for images and sounds that may pose a threat. If and when it finds a “hit”, it immediately triggers another part of the brain known as the Hypothalamus, which in turn triggers the “fight, flight, or freeze” hormonal response along the HPA—or hypothalamic-pituitary-adrenal—axis. The resulting hormonal surge of cortisol and adrenaline is what we experience as stress.

Variants of the body’s “orchid genes” can impact every stage of this biological process—and the SLC6A4 gene is especially of note. Serotonin is an important neurotransmitter that helps to regulate our sleep, appetite, mood and anxiety—and SLC6A4 is responsible for regulating serotonin levels in our brain’s synapses as well as in our gut. If you are born with an s/s variant on your SLC6A4 gene, you are genetically predisposed to have fewer serotonin “transporters” that help to transport serotonin to the places they need to go after the neurotransmitter is released in your body. Under stress, your brain’s synapses flood with serotonin, and if there are not enough transporters, all of that extra serotonin results in more “hits” in your Amygdala that in turn trigger your fight, flight or freeze response.

Scientists have long known the connection between serotonin and the stress response—but studies have now shown that the s/s variant on the SLC6A4 gene can also have dramatic implications to your gut response, too. Could SLC6A4 be the cause of that “I think I’m gonna be sick…” impulse?

SLC6A4, Serotonin, and Your Gut

Orchid individuals possessing an s/s variant on their SLC6A4 gene have fewer serotonin transporters and therefore more serotonin in their bodies. In the brain, too much serotonin can lead to an over-reactive “fight or flight” response. In the gut, too much serotonin can lead to a gut in dysbiosis, irritable bowel syndrome, frequent diarrhea and abdominal pain, and many other difficulties. In healthy guts, serotonin plays several key roles in regulating the gut, including promoting gut motility, modulating electrolyte absorption, maintaining fluid homeostasis, and regulating your gut permeability. However, studies show that increased serotonin levels result in overactive gut muscles, increased secretion and gut mucosal inflammation levels, and more pain for the patient. One study in particular showed that serotonin release was found to be ten times higher with patients suffering from IBS than those who did not!

Like I mentioned in the beginning of this blog, our bodies have a series of chain reactions designed to protect us—and a flood of serotonin is certainly one of them. But if your body is not equipped to process that serotonin effectively, then you might find yourself saying “I think I’m gonna be sick” a little too often for your liking. If you are an orchid individual, living with an increased stress response can be difficult enough. To compound those issues with issues stemming from your gut microbiome can make life harder. Luckily, for s/s variant “orchids”, there may be a light at the end of the tunnel.

Can You Make Your “Orchid” Gut Bugs More Resilient?

If you feel stressed or panicked and suffer from IBS or other gut difficulties, the very first step you can take in the right direction is working with a psychiatrist who can administer a genetic test, like Genomind’s Professional PGx Express test, that will shed light on what gene variants you’re working with in your journey towards better health. From there, you and your doctor can determine a treatment plan that is tailored specifically to your SLC6A4 variant. New medicines help to quell symptoms of IBS stemming from too much serotonin, and those medicines will become increasingly popular as the medical world moves towards precision medicine. If too much serotonin is leading your gut towards dysbiosis, a diet rich in prebiotics and probiotics may help bolster your defenses. The gut is centrally involved in many of our mental and physical concerns, and the more you know about your body, its genetics, and your own microbiome, the more you may be able to stave off uncomfortable “I think I’m gonna be sick” reactions.

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*Although lessons learned from the treatment of actual patients are included in the patient stories on this website and blogsite, the historical events and facts represented have been changed to protect the identities of any real patients and to protect their confidentiality. For example, the names, ages, careers, the number and sex of their children, as well as the careers of the patients’ parents have been deliberately altered, as well as other alterations that have been made. Consequently, all characters appearing on these sites are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.

**Author’s financial disclosure: Genomind and Potomac Psychiatry have an ongoing marketing collaboration aimed at raising visibility for Genomind pharmacogenomics services and Potomac Psychiatry’s Genetic Testing Consultations. Dr. Kehr holds no ownership interest in Genomind and receives no consulting fees.

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