Mental Health | Gut Health | Microbiome | Immunity
Is there a connection between mental health and gut health? And if so, is the connection in one direction, or in both directions? That is, can your brain’s health influence your gut function, and can your gut health have an influence on your brain, and thus, mental health?
Last month, I arrived two minutes before a six-hour continuing education lecture on the subjects of immunity, inflammation, and the gut microbiota was slated to begin, and there were but a few seats left in the crowded hotel conference room. Apparently, I picked a hot topic! The majority of the participants were nurses and doctors, and based on the speed of the note-taking I witnessed, there was great interest in the topic. However, I wouldn’t expect the average person to care, even though I think everyone should.
For you, I will disseminate those six hours of lecture into the best takeaways for you regarding the connection between your gut and your mental health. For our purposes here, I’ll try to keep the medical terminology simple and on point about its connection to brain health and mental health.
Your Gut: A World of Good Going on Down There
In general, most of don’t think about our gastrointestinal system until something goes wrong. Yet, our guts are performing incredible feats of metabolism day in and day out. When the microbiome, the microorganisms of your gut, is healthy, it unleashes the energy found in your food by breaking the food down into what the gut can deal with, extracting nutrients and shuttling it into your bloodstream.
When that microbiome is disturbed in some way, that’s when all intestinal hell breaks loose. Disturbances that overwhelm the microbiota, with over 1000 species of microorganism that reside in your gut and keep them humming, can cause gut dysbiosis. Gut dysbiosis is simply an imbalance of the gut flora, and you may have heard people refer to symptoms of it in such conditions as SIBO (Small Intestinal Bowel Overgrowth) of SIFO (Small Intestinal Fungus Overgrowth).
Essentially, we need these good gut bacteria to be in balance in order to function normally. They search and destroy the bad gut bacteria, protect us from other pathogens, and some of them help us absorb nutrients. The presence of these good gut bacteria are actually used as indicators of good health, just as the absence of them are measures of poor health.
To bring this down to a functional level, the health of your microbiome is directly related to the development of certain diseases and health problems, such as Crohn’s Disease, bacterial vaginosis, funguses, and even obesity.
The Brain-Gut and Gut Brain Connection
When the gut is has a healthy microbiome and is working properly, two other factors work together to influence your overall health: your stress level and your dietary intake.
Eat a healthy diet and keep your stress level under control, and the nutrients extracted from your food keep your cognitive processes functioning normally. Eat a nutrient poor diet, such as unhealthy fats (and/or just a lot of excess fat in the diet), excess processed sugars (found in high carbohydrate diets), or an overabundance of salt, and these throw a wrench in the system, forcing your gut and other organs to work harder, attempt to find workarounds (such as increase insulin production, overworking the pancreas, putting your kidney on overtime), and you deprive your brain from getting the nutrients you need to think straight! Add stress from work, home, or the news, and the increase in cortisol levels adds an additional workload to the body, forcing your organs to work overtime without much respite. When friends joke about eating so much they went into a “food coma,” that’s what I’m talking about!
This is, of course, a simplistic description of what happens. A more detailed example would be one where you decided to indulge in a large meal, a decadent piece of cake for dessert, followed by an indulgence of alcoholic beverages. You retire for bed, and your tummy feels awful. In the middle of the night, you get up with an urgent need to use the toilet, and a couple of bouts of diarrhea or an urge to vomit later, you go back to bed.
For the majority of people with a healthy gut, this isolated incident is no great cause for alarm. In a couple of days, you’ll feel recovered.
However, before that recovery happens, you might notice that you feel a little “off”, or slightly sluggish at work the next day. This is beyond the headachy feeling of a hangover related to the alcohol. That foggy feeling is something referred to as brain fog, a very real condition that affects people with long-term, chronic deprivation of nutrients because of a disease state affecting their ability to absorb nutrients from the gut. Sometimes referred to as “chemo brain”, it also shows up in people who have autoimmune diseases such as Lupus, multiple Sclerosis, and GI disorders like Celiac Disease, Crohn’s, and Irritable Bowel Syndrome or Irritable Bowel Disease.
The food giant industry jumped on the science of the 1970’s that showed that children who ate breakfast performed better in school. Unfortunately, they manipulated the science to put pressure on mothers of young children to feed their kids expensive sugary cereals, which caused a different set of health problems as they groomed a generation to become cereal-dependent, high carbohydrate eaters. Yet the one thing that we did understand is that nutrition did indeed have a direct connection to how the brain functions. You need to feed the brain; you also need to learn what to feed the brain to feel good.
Your Guts and Your Mental Health: Lifestyle Factors that Make a Difference
What about mental health? Is there a gut-brain connection there as well?
When I look at a person’s mental well being, I don’t limit an evaluation to the symptoms of a mental disorder or imbalance. I often ask my clients to talk about the interplay of four areas: 1) what’s going on in their life (stress), 2) what kind of exercise are they getting on a regular basis, 3) what kind of diet are they eating more often than not, and 4) what’s going on in the gut.
Asking about changes in their diet and their gut function might seem like an odd thing for a therapist to ask during a mental wellness evaluation, yet I’ve learned as both a Registered Nurse and a Licensed Mental Health Counselor to add those questions to start a dialogue with the client. Even if s/he decides to discuss the details with a nutritionist, a medical doctor, or no one else, at least I put it on their radar that these lifestyle factors can have a profound effect on the level of depressive, anxious, or cognitive processing symptoms that they are describing.
You may have heard a friend say something about the positive effects of running, such as, “Running is less expensive than therapy.” While I’ve never viewed running as a one-to-one replacement for psychological counseling of serious mental health issues, there is some truth to this statement. Exercise improves hormonal function and releases endorphins, which have a powerful effect on the brain’s “happy” neurochemistry, that sense of feeling lighter and less gloomy, despite circumstances remaining the same. For those who have no issues with mobility and report stress and depressed mood on a daily basis, exercise can be one aspect of a prescription for alleviating that depressed mood.
When you are able to decrease stress through either removing or decreasing the stressful source itself, or alternatively learning how to interpret the triggers of stressful thoughts (through meditation and reframing, for example), there is evidence that the gut is also positively influenced, such as less inflammation in the gut, decreased cortisol release, and decreased acid release in the stomach.
Here, my primary focus is on how the gut and diet can have profound effects on mood. Ever notice how coming off a “sugar high” can cause a colleague at work to be grumpy, careless, or sluggish? Similarly, have you noticed how a healthy snack at mid-day can act as a pick-me-up to being more productive and less stressed before leaving the office? A person who has suffered through multiple bouts of diarrhea can look like she has dragged herself through the desert, with fatigue, brain fog, listlessness, emotional lability, and thoughts of helplessness and hopelessness. Alternatively, that same person can bounce back with vitality after her gut has been rehabilitated with gut bacteria that prevents further nutrient loss and supports healthy gut function.
A diet that contains Vitamin D, plant-based foods, Omega-3 Fatty Acids, zinc and magnesium are things to look at when considering diet and mental health. These can mostly be obtained by eating real food and limiting processed foods that displace the micronutrients found in real food; the exception is Vitamin D, especially in people who live in northern latitudes (Seattle qualifies). A test for Vitamin D deficiency in the doctor’s office can help determine whether Vitamin D supplementation is needed to help ease the symptoms of depression, along with exposure to sunlight.
One buzz word you may have heard about is the need for prebiotics and probiotics in your diet. In regards to your microbiome, a healthy one has these species of good gut bacteria already present, and that bacteria is there when a person eats a healthy, balanced diet in conjunction with a well-functioning gut. However, when people choose to eat an unbalanced diet consisting of low fiber and high carbohydrates (think excess sugars), probiotics can be helpful to try to get that microbiome back into balance.
Prebiotic foods are the foods that the probiotics eats, so you need both in order to get the maximum impact of probiotic foods and supplements. I did notice that a good amount of the prebiotic food list are prohibited on an Autoimmune Protocol Diet, as they may cause inflammation, and some of them are absolutely prohibited on a Celiac diet.
Probiotic foods are fermented foods, such as yoghurt (watch out for the extra sugar added to some of these yoghurts)!, water kefir, kombucha, pickled foods, sauerkraut, miso, and kimchi. Again, some of these foods are prohibited on medically-necessary diets, so you may need to customize your choices. Alternatively, some people will choose to take a probiotic in pill form, selecting a high amount of the more common bacteria such as Lactobacillus casei, Bifidobacterium, and in the case of severe diarrhea, Saccharomyces boulardii (aka Saccharomyces b.)
It’s not what every therapist is trained to ask. But this therapist is! As always, you have the right to decline this conversation if you’re too shy to talk about your guts in session. However, I encourage everyone to consider how stress, exercise, diet, and gut function play integral roles in your everyday mental health. If you would like to talk more about this in a session, you’ll find me willing and helpful to explore your options in improving your healthy gut-brain connection as it pertains to your mental well-being
*My primary resource for this article is a limited summary of aspects of a six-hour lecture presented by Ginger Schirmir, PhD, RD, LD, CSSD, in combination with materials gathered over the course of the past five years. It is not designed to stand as replacement for sound medical advice from your licensed medical doctor or naturopathic doctor.