Rethinking Gut Health: Social Determinants, Mental Health, and Brain-Gut Therapies

The gut microbiome has become a fixture of consumer wellness culture, but for practicing gastroenterologists, the clinical reality of gut health is considerably more nuanced.

At Digestive Disease Week (DDW) 2026 in Chicago, IL, Laurie Keefer, PhD, a health psychologist and professor of medicine at the Icahn School of Medicine at Mount Sinai, led a session calling on clinicians to expand their framework for gut health, one that accounts for the psychosocial forces shaping their patients' lives and explicitly integrates mental health into GI care.

"Gut health is a hot topic right now," Keefer told HCPLive. "If you go on TikTok, it means one thing. If you come to DDW, it means another."

The Social Determinants Shaping Gut Health

For clinicians, gut health encompasses far more than diet or supplement use. Keefer emphasized that the full range of social determinants and lifestyle factors, including chronic stress, physical inactivity, loneliness, and ongoing exposure to conflict and geopolitical instability, all influence the gut microbiome and contribute to dysbiosis. Research has increasingly linked social isolation and loneliness to reduced gut microbial diversity, itself associated with a range of inflammatory and cardiometabolic conditions.

"All of our patients should be concerned about their gut health, because they live in this world today," Keefer said.

The Bidirectional Mental Health Connection

A central theme of Keefer's session was the inseparability of gut health and mental health. The United States is in the midst of a recognized mental health crisis, and the gut-brain axis sits squarely at the intersection of these public health challenges. The microbiota-gut-brain axis is a complex, bidirectional communication network linking the central nervous system and the gastrointestinal tract, with growing evidence that gut health can impact mental well-being and vice versa. For clinicians, this means that anxiety and depression are not merely comorbidities to be managed separately, but rather act as active drivers of gut dysfunction, and gut dysfunction can perpetuate them.

"You can have depression and anxiety that affects your gut health, and your gut health can lead to depression and anxiety," Keefer explained. "We really can't disentangle those two things."

Brain-Gut Behavior Therapies in Practice

The third pillar of Keefer's session addressed the clinical role of brain-gut behavior therapies (BGBTs), a class of interventions that includes cognitive behavioral therapy, gut-directed hypnotherapy, and other psychologically informed approaches. These therapies target not only lifestyle and mental health, but also the way patients perceive and respond to GI symptoms.

BGBTs are short-term, clinician-administered interventions, and a 2025 systematic review and network meta-analysis published in The Lancet Gastroenterology & Hepatology found that several, particularly those classified as brain-gut behavior therapies, are efficacious for global IBS symptoms.

Keefer framed this perceptual component as underappreciated in routine care. How a patient interprets mild bloating, and what behavioral response that triggers, can meaningfully shape the downstream course of their gut symptoms.

"We're targeting things like lifestyle and behaviors and mental health, but also the way symptoms are perceived," she said. "Really full circle, but not separating gut health from mental health."

Editors’ note: Keefer reports relevant disclosures with AbbVie, Ardelyx, Eli Lilly, Janssen, Pfizer, and others.

References

1. Keefer L. PSYCHOLOGICAL APPROACHES TO IMPROVE GUT HEALTH. Session presented at: Digestive Disease Week (DDW) 2026; Chicago, IL; May 2–5, 2026.

2. Culli L. Nearly 1 in 10 Adults in the U.S. Experienced a Mental Health Crisis Last Year. Johns Hopkins. August 19, 2025. Accessed May 3, 2026. https://publichealth.jhu.edu/2025/mental-health-crisis-hits-nearly-1-in-10-us-adults

3. Thakur ER, Khasawneh M, Moayyedi PM, et al. Efficacy of behavioural therapies for irritable bowel syndrome: a systematic review and network meta-analysis. The Lancet Gastroenterology & Hepatology. doi:10.1016/S2468-1253(25)00238-9