If someone asked you to name the most significant development in mental health in the last decade what would you say?
It would have to be big.
It would have to have the potential to challenge much of what we understand about how mental health symptoms develop, and help to inform more effective treatments.
I know exactly what I would say to that question.
It would have to be the explosion of knowledge about the gut-brain axis.
This is the powerful concept that our brains and digestive tract have the capacity for ongoing bi-directional communication, and that this conversation has everything to do with how our brains function and whether or not we will develop mental health symptoms.
You might have read that and thought, “but haven’t we known that forever?”
What we have known for decades is that our emotions have a direct impact on our guts.
This is true for all of us, but particularly for those with mental health symptoms.
Think about the last time you were really anxious. Did your stomach get upset, or did you lose your appetite?
Researchers have long known that emotional stress worsens Functional Gastrointestinal Disorders like Irritable Bowel Syndrome (IBS).
But that’s not the part of the story that will make headlines.
Up until about 5 years ago, suggesting that Gastrointestinal (GI) issues could cause mental health symptoms would have been viewed as heresy within conventional medical circles.
I read an article last month in the New York Times entitled “Germs in Your Gut are Talking to Your Brain.”
It opens with a story about an Irish microbiome expert who presented to a group of Dementia and Alzheimer’s researchers in 2014.
He shared the findings of the then most current research on the gut-brain connection, which showed that gut microbes could affect mood by directly communicating with the brain.
The takeaway was that gut heath directly impacts brain health.
The article notes that his presentation was not well received. He was quoted as saying, “I’ve never given a talk to so many people who didn’t believe what I was saying.”
That was less than 5 years ago. Since then, a lot has changed!
Research on the importance of the gut-brain connection seems to be coming out every week, and it’s now well accepted that gut issues can lead to brain impairment and mental health symptoms.
The research is still young, and much of it still in animal models, but if what we know now continues to generalize to human populations, we are on our way to a real paradigm shift in mental health.
The Nervous System and the Vagus Nerve
When most people think of neurons, they think of the brain and its magical ability to influence behavior. The brain has 100 billion neurons that control much of what we think and do.
What most people don’t know is that your gut also contains it’s own nervous system, composed of 100 million neurons, called the Enteric Nervous System (ENS). The ENS is so sophisticated it’s been dubbed the “second brain.”
Much of the communication between our two “brains” happens via the Vagus Nerve, which is the longest nerve in the Parasympathetic Nervous System. This is the “rest and digest,” relaxation part of the nervous system.
Many studies have shown that stress can travel from the brain to the gut, causing gastrointestinal problems (this would be brain-to-gut communication.)
But amazingly, 90% of the signals passing between the brain and gut are generated by gut neurons. It is these signals that have the ability to affect our mind and mood.
In fact, it has been shown that signals up the Vagus Nerve (gut-to-brain) can trigger the body’s stress response through communication with the Hypothalamic-Pituitary-Adrenal axis (HPA), initiating the release of the stress hormones cortisol and adrenaline.
The powerful takeaway here is that any problems in the GI tract, such as inflammation of the gut lining, can trigger our “flight/flight” stress response. When this pathway becomes chronic, it can lead to mental health issues including anxiety, depression and PTSD.
This is a very important finding if we are thinking about the etiology and treatment of mental health symptoms.
The Gut Microbiome
Another major player in the gut-brain axis are the microbes that call our large intestines home.
Did you know you have ten times more microbes in your gut than you have cells in your body?
We mostly live symbiotically with these little critters and through evolution have come to rely on them for our survival.
Some of the ways the microbiome helps us with essential bodily functions include aiding in digestion, regulating our immune system, helping to keep disease causing bacteria at bay, producing numerous B vitamins (including B12, thiamine, and riboflavin) and making vitamin K. In fact, we would to toast without them.
When there are mostly helpful or neutral species of microbes in our gut, and a limited number of “pathogenic species” know to cause illness, we would say that we have a “balanced flora”.
“Dysbiosis” refers to the changes in the composition of microorganisms in our gut, so that disease-producing organisms overpower the more “friendly” microbes.
A recent population-level study was the first in humans to look at the link between gut bacteria and mental health. It found two specific bacterial genera, Coprococcus and Dialisterl, that were consistently depleted in people with depression, regardless of antidepressant treatment.
What Causes Dysbiosis?
The simplest answer is—modern life.
Known causes of disruptions of gut flora include:
-Processed foods and sugar
-Antibiotics (much of it coming from conventionally raised animals)
-Pesticides, herbicides, preservatives and other toxins
-High alcohol consumption
There are others but these are some of the big ones.
Importantly, dysbiosis has been show to directly affect cognition and mood, and recent research has shown that “modifications of the microbiome can induce depressive-like behavior.”
So gut dysbiosis can be bad news for mental health.
Unchecked gut dysbiosis and ongoing exposure to the modern gut flora busters, described above, sets the stage for inflammation of the gut lining.
One thing that amazed me was finding out that the gut lining is only one cell thick, and this one cell thick barrier may be the most important gatekeeper of the body.
Inflammation of the lining of the small intestines (where most nutrients are assimilated) often results in a condition know as Leaky Gut.
What is “Leaky Gut?
It’s a condition where gut barrier breaks down, and allows undigested food particles, pathogens and toxins to enter the body.
This flips the immune system into a hyper-alert mode, leading to systemic inflammation, allergenic, and even autoimmune reactions.
Some conditions that can be caused by the metabolic fallout of leaky gut include: anxiety, depression, migraines, eczema, food allergies and autoimmune conditions like rheumatoid arthritis and Hashimoto’s thyroid.
The damage to the gut lining in leaky gut also leads to nutritional deficiencies caused by poor absorption.
When nutrients needed for the production of neurotransmitters (the fee-good chemicals of the brain, such as serotonin and dopamine) are not available, anxiety and depression can arise. These nutrients include: Zinc, magnesium, specific B vitamins and amino acids.
Leaky Gut, Leaky Brain
Some of the latest research shows that having leaky gut can often lead to deterioration the blood brain barrier (BBB), often referred to as a “leaky brain.”
When these two protective barriers (the gut lining and the BBB) become compromised, our bodies and brain become vulnerable to infection and inflammation, which can lead to symptoms of depression, anxiety, cognitive impairment and brain fog.
Symptoms of Gut/Brain Axis Issues
So is it possible that gut issues are causing or making your mental health symptoms worse?
If you have known GI issues like IBS, constipation, diarrhea, candida, or SIBO, as well as mental health symptoms, it’s likely that your gut issues are at least exacerbating your mental health condition.
It’s even possible that they are the “root cause.”
But, even if you have anxiety and depression and don’t have obvious GI symptoms, the gut-brain axis might still be involved.
Here are some common symptoms of GI dysbiosis and/or leaky gut (remember they usually go hand in hand):
-Headaches, brain fog, memory issues
-Skin rashes and problems such as acne, eczema or rosacea.
–Autoimmune disorders (such as Hashimoto’s thyroiditis)
–Arthritis or joint pain.
-Vaginal or rectal itching
-And of course mental health symptoms including depression, anxiety and ADHD, or mood swings.
Remember, you don’t have to have all of these symptoms to suspect gut involvement in mental health symptoms.
So how can you help yourself?
Here are some general tools that have helped many people address the gut component of their mental health issues.
1) If you haven’t already, switch to eating organic
Organic food is real food.
Eating organically lessens your exposure to gut-destroying pesticides and genetically modified foods.
You’ll be protected from possibly the worst offender of all – the herbicide Glyphosate, which is commercially sold as “Roundup.”
According to MIT researcher Dr. Stephanie Seneff, PhD:
“Our gut bacteria contains the same metabolic pathway found in plants that is targeted by Roundup. Is it any wonder that leaky gut syndrome, IBD, colitis and other gastrointestinal diseases have spiked since the onset of Roundup ready GMO crops?”
Additionally, non-organic meats have been shown to have high levels of antibiotics, which, as stated above, cause dysbiosis and significant GI damage.
If you have mental health symptoms and GI issues, do yourself a favor and eat organic foods as much as possible.
2) Do an elimination diet
Elimination diets give your gut a break.
They remove foods that are known to cause inflammation or allergenic responses in many people. This just calms everything down, and lets the gut begin to heal.
Though there are some variations on what’s removed, most elimination diets restrict:
-Processed foods (chemicalized artificial junk foods)
-Sugar and alcohol.
All elimination diets focus on eating real food, including a wide variety of vegetables, pastured and grass-fed meats and good quality fats.
I have had good success with the Whole30, which is an easy to follow 30-day elimination diet, with a structured reintroduction.
The reintroduction phase allows you to pinpoint the specific foods that trigger symptoms. In my experience, the reintroduction step is invaluable.
3) Find a way to reduce stress
Stress reduction in one of the most underappreciated tools for healing.
Remember, stress can cause gut inflammation, dysbiosis and leaky gut.
With a daily stress management practice, you can jumpstart the gut healing impeding your mental health recovery.
The important thing is to find a practice, or a few practices, that you like, and to do them daily.
Several that I find helpful include:
HeartMath– Much used biofeedback tool for increasing heart rate variability, which has been shown to decrease stress.
Practice Gratitude – By focusing on being thankful for things on a regular basis, we cultivate healing. People who practice gratitude have less depression and anxiety, sleep better, experience more compassion and kindness and are healthier overall.
4) Work with a skilled functional medicine practitioner.
Find a trained partner to work with you on your gut issues.
This person might be a doctor or other licensed medical provider, or they could be a well-trained health coach with expertise in functional lab testing.
Their experience is more important than their title.
This person will help you assess whether you have gut issues contributing to your mental health symptoms, will help you identify the “root causes” of these symptoms, and will come up with a targeted treatment plan.
You need to know the cause of the issue for most effective healing.
Finding a practitioner with a mental health focus (who also has skills with GI healing and repair) would be ideal.
Here are several places to start looking. I also do telemedicine sessions focused in this area:
So what now?
If you found this interesting, keep on educating yourself about the gut-brain connection. With all the research pouring out, this is just the beginning.
If you suspect that your gut issues might be preventing your mental health healing, set up an initial consult with me.
Advanced functional testing now allows for a deep look into issues like leaky gut and bacterial overgrowth, that are known to cause mental health symptoms.
With the results, there’s a lot we can do to get you on the right track to healing. If you’re interested, contact me at firstname.lastname@example.org or call 402-709-6161. I am always glad to answer questions.
If you are excited to learn more about some of the other physical factors that affect mental health, check out some of my previous blogs.
Yours in good (mental) health,
Dr. Josh Friedman has more than 25 years experience in mental health as a client, psychologist, and functional nutrition practitioner. After working in the field for a few years, he realized how many people were still struggling with depression and other mental health issues even after years of therapy and medication. Over time he became increasingly uncomfortable with the limitations of standard psychiatric treatment and knew there had to be a better way. Over the past decade and a half, he has committed himself to learning as much as he could about the root causes of mental health symptoms. To share this information and to help people get unstuck, he started Alternative Mental Health Solution.