You know the feeling. You’re stressed, overwhelmed, or dreading something, and suddenly your stomach ties up in knots. Your digestion goes sideways, your skin flares, and your PMS gets inexplicably worse.
It’s easy to chalk these things up to coincidence, but according to one leading women’s health expert, what’s happening is physiological.
We sat down with Dr. Sarah de la Torre, a double board-certified physician and OBGYN to find out more. With over 25 years of experience in women’s health, hormone optimization, and functional medicine, she unpacks the connection between stress, anxiety, and your gut, as well as what you can actually do about it.
Your gut is basically a second brain.
If you’ve ever said “I feel it in my stomach” during a stressful moment, Dr. Sarah wants you to know that it’s not all in your head.
“The gut is known as the ‘second brain’ because it has its own nervous system—the enteric nervous system—and it’s in constant communication with the brain via the vagus nerve,” she explains. “So when your brain perceives stress, your gut feels it almost instantly.”
When stress hits, the body floods with cortisol and adrenaline, pulling blood away from the digestive system. Digestion gets deprioritized, fast.
“That changes motility, enzyme secretion, and even how the gut muscles contract,” she says.
The gut lining can also become more permeable under stress, and the microbiome’s bacterial balance starts to shift. Throw in common stress-coping habits like alcohol or a poor diet, and the disruption compounds.
“Because the gut is also a major immune and hormonal interface, this shift doesn’t just affect digestion. It affects inflammation, signaling, and how the body processes nutrients.”
Chronic stress changes what's actually living in your gut.
Short-term stress is one thing. But when stress becomes chronic, the effects go deeper—all the way down to the bacterial community living inside you.
“About 70% of the immune system lives in the gut, and the microbiome plays a huge role in regulating inflammation, neurotransmitters, and even estrogen metabolism,” Dr. Sarah explains.
Over time, elevated cortisol reduces beneficial bacteria particularly the ones responsible for producing serotonin and short-chain fatty acids, while more inflammatory species can take hold. This also increases intestinal permeability, better known as “leaky gut,” which allows inflammatory signals to move into the bloodstream and creates a ripple effect throughout the entire body.
“What I see clinically is that women often don’t make the connection between their stress, their gut, and whole-system effects,” she says. “It can show up as increased food sensitivities, bloating, irregular digestion, skin flares, worsening PMS, hormonal dysregulation, and mood symptoms like anxiety and mood variability. Once the gut is dysregulated, the ripple effect touches almost every system.”
Here’s how the sleep–gut–anxiety cycle works.
This is where things get interconnected. Poor sleep doesn’t just make you tired; it actively disrupts your gut, which then worsens your anxiety and makes it even harder to sleep.
“Even a few nights of poor sleep can increase cortisol, impair glucose regulation, and shift the microbiome toward a more inflammatory state,” says Dr. Sarah.
The microbiome, it turns out, runs on a circadian rhythm too. Disrupt that rhythm and you get reduced microbial diversity, a weakened gut lining, and changes in how neurotransmitters are produced, all of which feed back into the brain and amplify anxiety.
Dr. Sarah sums up the cycle this way: “Poor sleep equals higher stress hormones, equals disrupted gut, equals increased anxiety, equals worse sleep.”
“Breaking out of it,” she says, “isn’t about perfection; it’s about consistency.”
Here are her most impactful recommendations:
- Stabilize your sleep and wake times (even more than total hours).
- Get morning light to anchor your circadian rhythm.
- Support your nervous system before bed with downregulation practices.
- Eat regularly to keep blood sugar and cortisol steady.
“When sleep stabilizes, gut function and anxiety often follow,” she tells us.
Most of us are well-acquainted with the spiral of anxiety the morning after drinking. There’s real science behind it.
“Alcohol initially increases GABA, which is calming, and dopamine, which feels good,” Dr. Sarah explains. “But as it’s metabolized, there’s a rebound effect. GABA drops and glutamate rises. That creates a more anxious, wired state the next day.”
Meanwhile, alcohol disrupts the gut microbiome, reduces the bacteria involved in serotonin production, and increases gut permeability, amplifying inflammation and affecting brain signaling. Add blood sugar crashes, dehydration, and fragmented sleep, and you have what she calls “the perfect storm for anxiety.”
“That hangxiety feeling isn’t just psychological,” she says. “It’s neurochemical, metabolic, and microbial all at once.”
And some women are more sensitive to it than others, particularly those in perimenopause, when the nervous system is already running more reactively.
Stress, anxiety, and gut health aren’t separate issues to troubleshoot independently of each other. They’re part of one interconnected system that’s constantly communicating, and when one area is dysregulated, the others feel it.
The good news, according to Dr. Sarah, is that the reverse is also true. Support one, and the others tend to follow. Better sleep, consistent meals, less alcohol, and genuine nervous system care aren’t just wellness talking points. They’re what the body actually needs to reset.
Dr. Sarah de la Torre is a double board-certified physician and founder of Lumani Wellness. Learn more at lumaniwellness.com.
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