Woeller, Kurt D.O.
The Role of Diet and the Gut in Mental Health
Terri Hirning
While the traditional mental health model focuses on brain function, neurotransmitters and potentially pharmaceutical medications, the ever burgeoning integrative mental health field understands there is more to it than that. Even mainstream media is starting to get the hint. Our gut influences our mind, emotions, cognition and mental health more than we've given it credit for in recent history. Whether we want to focus on the role food allergies play on mental health (1), (2) or how the gut-brain axis impacts our mental health (3), or even how the microbiome shapes our mental functioning (4) we can see the trend in research confirming what many integrative physicians and clinicians know: the gut matters
When we talk about the gut, we must cover diet. Some literature even suggests that a debilitating mental health disorder like Alzheimer's now be called "Type 3 Diabetes" (5) because of its links to certain kinds of foods and a generally poor diet. What is causing the alarming trend of food allergies, food sensitivities and the increase in auto-immune conditions? Is it GMO's? Is it Glyphosate (the herbicide used in products like Monsanto's Roundup)? Is it the prevalence of processed grains in our diets now? It may be all of thesethings, or none of these things, but as physicians and clinicians, the data suggests we take a closer look at our patients' diets and here are some things to consider:
Is there an underlying food allergy or multiple allergies? This can be an easy and yet very powerful place to start. Research shows that food allergies can indeed cause manifestations of mental health disorders. Running a simple IgG food allergy test from the Great Plains Laboratory, which also includes markers for Candida (harmful fungus in the gut) can be a great first step. More mainstream information on the treatment of Celiac disease can be also helpful in finding its connections to many mental health disorders like dementia, seizures, schizophrenia, etc.(6), and one does not have to be diagnosed with Celiac disease to be sensitive and reactive to gluten.
What about healthy gut function and microbiome population? Our microbiome is sensitive to our diets, and quickly reactive to changes. Looking at potential gut dysbiosis and the levels of beneficial flora in the gut is very important. An organic acids test will show you a wide range of metabolic markers, including several for bacteria (like Clostridia) and fungus (like Candida albicans) in the gut. If a patient has high levels of these, a course of treatment can be started to rid them of these invaders, possibly including dietary restrictions (like a low sugar, low carb diet) and adding helpful antibacterial or antifungal supplements. Then, to assess the beneficial bacteria in the gut, you may want to run a comprehensive stool analysis. This will help determine whether a patient needs to add a high-quality probiotic supplement to their diet and possibly increase his/her intake of probiotic-rich and fermented foods like kefir and sauerkraut.
Today's mental health disorders are very complex. Their treatment requires a well-rounded look at the many factors impacting the body and brain, including diet, lifestyle, the microbiome, and more. When an integrative approach is used and these many factors considered when creating a treatment plan, time and time again we see improvements in functioning and a reduction in clinical symptoms.
Clinical References:
Jackson J1, Eaton W2, Cascella N3, Fasano A4, Santora D5, Sullivan K6, Feldman S6, Raley H7, McMahon RP6, Carpenter WT Jr6, Demyanovich H6, Kelly DL8.Gluten sensitivity and relationship to psychiatric symptoms in people with schizophrenia Schizophr Res. (2014) Oct 10. pii: S0920-9964(14)00511-8. doi: 10.1016/j.schres.2014.09.023.
Genuis SJ1, Lobo RA2. Gluten sensitivity presenting as a neuropsychiatric disorder . Gastroenterol Res Pract. (2014);2014:293206. doi: 10.1155/2014/293206.
Nemani K1, Hosseini Ghomi R2, McCormick B3, Fan X3. Schizophrenia and the gut-brain axis. Prog Neuropsychopharmacol Biol Psychiatry. (2014) Sep 19;56C:155-160. doi: 10.1016/j.pnpbp.2014.08.018.
Severance EG1, Yolken RH2, Eaton WW3. Autoimmune diseases, gastrointestinal disorders and the microbiome in schizophrenia: more than a gut feeling. Schizophr Res. (2014) Jul 14. pii: S0920-9964(14)00319-3. doi: 10.1016/j.schres.2014.06.027.
De la Monte S, Wands J. Alzheimer's Disease Is Type 3 Diabetes–Evidence Reviewed. J Diabetes Sci Technol. (2008) 2(6): 1101–1113.
Velasquez-Manoff Moises (2014 October 12). Can Celiac Disease Affect the Brain? The New York Times. Retrieved from:http://www.nytimes.com/2014/10/12/opinion/sunday/can-celiac-disease-affect-the-brain.html?smid=tw-share&_r=0
Tiny Friends in Hidden Places (But Sometimes They "Unfriend" You): Man's Evolving Relationship with the Microbiome
Pamela Gilford, MA, CCN
Acceptance of the germ theory of disease unleashed a two-century war between humanity and the unseen microbial world. First, better sanitation, and after WWII, the advent of antibiotic treatment, saved millions of lives. Bacteria were the enemy; babies were even bathed in a toxic, chlorinated wash now withdrawn from the market. The presence of bacteria in the GI tract was treated as nature's "mistake." Who cared that oral antibiotics killed off some gut flora? Oral delivery avoided that unpleasant shot in the buttocks.
The mysterious rise in autoimmune disease since the development of modern antibiotic therapy has been one clue that humans might not be winning the war against microbes (see references below). A slow reassessment of the microbes, grudgingly referred to as "GI commensals" (harmless organisms) began. The genesis of pathogenicity has been discovered to be a two-way street between the human immune system and microbes, now referred to as a "relationship". Multi-celled, "higher" organisms clearly coevolved with one-celled organisms to mutual benefit. Microbes help us digest our food and provide certain vitamins. The microbes that line most of our GI tract defend our GI mucosal lining against invading pathogens, and as they begin to colonize the sterile gut of a newborn, they "educate" the child's immune system.
Multi-celled host organisms (like us) provide food, water, physical safety, and transportation. How else could microorganisms have extended their range without transportation? Humans have been particularly helpful. If this notion seems odd, think about syphilis coming to the New World with the first ocean explorers, and more recently, HIV and ebola making the crossing.
Although the variety of our GI flora has been known for a long time (See Theodor Rosebury's Life on Man, 1969), the advent of DNA tools to catalog species has spurred new interest in how human metabolism interacts with GI flora. The National Institute of Health's huge Human Microbiome Project is now nearing completion (seehttp://www.hmpdacc.org/). Evidence-based probiotic supplements for medical use are eagerly anticipated, although the first truly "evidence-based"probiotic was probably Lactobacillus GG, or Culturelle, discovered in cheek swabs by two researchers from Tufts University (see references below). Goldin and Gorbach patented Culturelle in 1985 for treatment of diarrhea caused by Clostridia difficile in children and has since been the subject of several hundred studies. Subsequent DNA analysis has granted this strain of bacteria a species designation of Lactobacillus rhamnosus and it is now incorporated into many commercial probiotic blends.
Studies have shown that variations in the species composition of gut microflora are related to the risk of obesity and that probiotic treatment often improves mood (see references below). Inflammation, which can be modulated by healthy gut flora, has become definitively linked to the epidemic of depression worldwide, as well as the genesis of many chronic diseases (see www.Medscape.com – many articles).
Clinical Endocrinology News reports that 64% of family physicians are stressed and uncomfortable when faced with treating autoimmune disease (see reference below) The fact that available allopathic therapies come with substantial side effects does not improve the practitioners' or patients' comfort levels. The frustration of both in finding safe therapies for autoimmune and chronic disease has certainly contributed to the growing popularity of integrative or CAM approaches. An article in Science magazine from November 2013 (see reference below) cited research by Mathis and Littman who found that Prevotella copri was present in 75% of RA patients' intestines. Later, they were able to trigger inflammation in mice by inoculating with the bacterium. Such studies add weight to clinicians' observations that probiotic treatments and even fecal implants can often halt the progress of chronic diseases.
We have been discussing our microbial passengers and an important part of the organic acids test is the assessment of the level of metabolites of pathogenic microbes, including yeast and Clostridia bacteria. The COMP stool test cultures both beneficial and potentially pathogenic microbes and microscopic examination can catch both yeast and one-celled parasites. When we added the Candida marker to the IgG food allergy test, we discovered a very useful tool for determining if a patient has become sensitive to his/her own native fungal flora. At The Great Plains Laboratory, we believe that the metabolic and and toxic element assessments we offer assist in directing treatment protocols that can mediate many chronic conditions, eliminate harmful microbes, and reinforce beneficial gut flora for improvement in overall health.
Clinical References:
Hunter, P. 2012. The changing hypothesis of the gut. The intestinal microbiome is increasingly seen as vital to human health. Science and Society DOI 10.1038/embor.2012.68 |Published online 15.05.2012, EMBO reports(2012)13,498-500
Thomas Jefferson University. 2014. Can antibiotics cause autoimmunity? ScienceDaily. March 31, 2014:http://www.sciencedaily.com/releases/2014/03/140331153520.htm
Chalmers, R.A., Valman. H.B., and Liberman, M.M., Measurement of 4-hydroxyphenylacetic aciduria as a screening test for small-bowel disease. Clin Chem 25:1791, 1979
Whiteman, H. 2014. Antibiotic use in children linked to juvenile idiopathic arthritis. Medical News Today. November 16, 2014:http://www.medicalnewstoday.com/articles/285453.php
Parry, W. 2011. Overuse of antibiotics is seen behind many human ills. LiveScience. August 24, 2011:http://www.livescience.com/15740-helpful-bacteria-antibiotics.html
Golden, B.R. and Gorbach, S.L. 2008. Clinical indications for probiotics: An overview. Clinical Infectious Dieases 46(12): S96-S100.
Mason, J. 2013. Can probiotics keep my gastrointestinal system happy? Tufts Now. September 16, 2013:http://now.tufts.edu/articles/can-probiotics-keep-gastrointestinal-health
Baumler, M.D. 2013. Gut bacteria. Today's Dietitian. June 2013: http://todaysdietitian.com/newarchives/060113p46.shtml
Wells, J.M. and Allison, C. Molecular genetics of intestinal anaerobes. In: Human Colonic Bacteria. Role in Nutrition, Physiology, and Pathology. Gibson and MacFarlane, ed. CRC Press. Ann Arbor. 1995. Page28
10. Conway, P. Microbial ecology of the human large intestine. In: Human Colonic Bacteria. Role in Nutrition, Physiology, and Pathology. Gibson and MacFarlane, ed. CRC Press. Ann Arbor. 1995. Pages 1-24