Diet Plays Important Role for Mental Health says the Association for Psychological Science in an article published on November 17.[i]
I will refrain from sarcasm here (not even a single “Really?! Who knew?!” (oops…that one just slipped out, darn it!….)) because at least they did write about it and are looking at the science. This is a sore subject for me. Why? I’ll put it this way: after 20+ years in the autism world, I am often asked what the best treatment is for autism in my experience. The Specific Carbohydrate Diet is still, by far, number one in my book. I have seen more kids, of all ages and functioning levels, improve via diet than any other treatment. I left special education, in fact, to work as a nutritionist for a reason. There is nothing like the right diet to improve health, and when I say health, I mean both physical and mental. And yet….
…the authors of this paper point out that nutrition is not a part of mainstream medicine when it comes to mental health. I am sure that’s true, unfortunately, but it’s actually far worse than that. Many doctors have told me over the years that they had 1 week of nutrition in their 4 years of medical school. So, nutrition is not actually a part of mainstream physical medicine either. Are any of asked about our diets in the 5 minutes we have for our annual physicals?
And yet, a healthy diet is probably the single most fundamental source of good health.
This article showcases 5 papers that give a good, broad example of the kinds of crucial information demonstrated by the limited research on this topic.
The first paper is a large-scale study of the broader Mediterranean lifestyle that includes diet, exercise and social activity. Looking at almost 12,000 people, the researchers found that each variable independently predicts a lower risk of depression.
The 2nd article compared 21 children with ADHD to an equal number of matched controls. The children with ADHD consumed the same amount of essential fatty acids (EFA) and yet, they still showed signs of deficiency. Also, those with lower EFA intake were also most likely to show greater ADHD symptoms.
The next paper looked at using the amino acid NAC (n-aceytl-cysteine) to treat obsessive compulsive disorder. While the study showed no statistical difference between the groups, subgroup analysis did show that those who had OCD symptoms for a shorter period of time did seem to improve. The researchers recommend retesting with a larger sample size.
The 4th paper was a small (14 adults) 8 week open-label study of the effects of micronutrients (vitamins and minerals) on insomnia. The participants all reported improvements in insomnia as well as mood, stress and anxiety.
The final paper was on the relationship of inflammation and depression. The researchers examined data on diet from over 4000 adults over a 5 year period and found that those with diets that would be considered inflammatory had a markedly increased risk of developing depression.
I will be writing a lot more about the importance of diet on this blog over time as it is crucial for good health, remembering that of course, diet also directly affects the gut biome…which in turn, directly affects health. In fact, here’s a teaser for my next post: a recent article in Cell showed that a fiber-deprived gut leads to degradation of the colonic mucosal barrier. And yes – that is a very bad thing!
This morning, I read about a really interesting randomized, double-blind study[i] done on 60 patients with Alzheimer’s disease. 30 of the patients were in the control group, and were just given ordinary milk. The 2nd group of 30 was given milk with a mixture of high-dose probiotics. The probiotic mixture had four kinds of probiotic bacteria: Lactobacillus acidophilus, L. casei, L. fermentum, and Bifidobacterium bifidum (approximately 400 billion bacteria per species – so a total of around 1.6 trillion organisms). At the end of the 12 week-long trial, scientists looked at both blood work and cognitive functioning. While the treated group remained significantly cognitively impaired, they did show statistically significant improvement over the controls. They also noted that blood work improved, including C-reactive protein, which is a marker for inflammation.
This is the first time that probiotics have been proven to improve cognition in humans.
Science Daily, which covered this story, quoted an Alzheimer’s researcher’s (not involved in this study) comments on the paper:
“This early study is interesting and important because it provides evidence for gastrointestinal (GI) tract microbiome components playing a role in neurological function, and indicates that probiotics can in principle improve human cognition. This is in line with some of our recent studies which indicate that the GI tract microbiome in Alzheimer’s is significantly altered in composition when compared to age-matched controls…”[ii]
The implications of this are huge, obviously. We know, for example, that the microbiome is altered in autism, and most cases of autism are associated with cognitive deficits. What other “mental illnesses” associated with cognitive loses then might probiotic therapy help?!
[i] Elmira Akbari, Zatollah Asemi, Reza Daneshvar Kakhaki, Fereshteh Bahmani, Ebrahim Kouchaki, Omid Reza Tamtaji, Gholam Ali Hamidi, Mahmoud Salami. Effect of Probiotic Supplementation on Cognitive Function and Metabolic Status in Alzheimer’s Disease: A Randomized, Double-Blind and Controlled Trial. Frontiers in Aging Neuroscience, 2016; 8 DOI: 10.3389/fnagi.2016.00256
We know that the brain and immune system are directly connected. We know that 70% or more of that same immune system is located in the lining of the nose and digestive system. And we know that the digestive system is directly connected to the brain. While we’ve known much of this for decades (except for those lymphatic vessels connecting the brain to the immune system, as per my last post), what has become one of the hottest areas of research now worldwide is the study of how the non-human living organisms of our biome directly affect the brain.
The human body houses about 100 trillion organisms with their own DNA. It’s astounding that we are only 10% ourselves as those organisms outnumber our cells 10 to 1. I laughed when I read this article a few weeks ago, “Do Microbes Control Our Mood?”[i] which starts off by saying, “If aliens were to examine a human, they would think we were just slavish organisms designed to feed microbes and carry them around.”
So true! We do indeed serve our co-inhabitants, housing them, feeding them, and if we’re smart, caring for them. The human biome is now recognized as being so integral to health, it is now considered a bodily organ, just like your heart or liver.
How these organisms affect the brain is a hot topic in science research now. We do know that they communicate with the brain directly. They also have profound indirect effect on the central nervous system. For example, they help us fight pathogens (thereby, playing an integral part in immunity, which affects the brain) and they make key vitamins that affect the functioning of the central nervous system.
Just this morning, I came across several new papers on this very subject. One article in particular blew me away: “The Gut-Brain Axis, BDNF, NMDA and CNS Disorders.”[ii] This came out just this past Friday, and describes how disruption of the gut biome during development negatively affects BDNF (brain derived neurotrophic factor) and the NMDA receptors, which in turn affect synaptic plasticity and cognitive function. Let’s simplify this:
“In the absence of GI microbes, central BDNF levels are reduced and this inhibits the maintenance of NMDAR production. A reduction of NMDAR input onto GABA inhibitory interneurons causes disinhibition of glutamatergic output which disrupts the central signal-to-noise ratio and leads to aberrant synaptic behaviour and cognitive deficits.”
So, here we have just 1 potential mechanism whereby altering gut bacteria may affect brain development and cognition. Within minutes of finding this article, I found this one, published in September, “Cognitive Function and the Microbiome,”[iii] which states:
“Cognition was originally thought to be exclusively regulated by the central nervous system, with long-term potentiation and neurogenesis contributing to the creation and storage of memories, but now other systems, including, for example, the immune system and the intestinal microbiome may also be involved.”
And then I found this one, also just published, “The Central Nervous System and the Gut Microbiome”:[iv]
“…emerging data suggest communication between the gut and the brain in anxiety, depression, cognition, and autism spectrum disorder (ASD). The development of a healthy, functional brain depends on key pre- and post-natal events that integrate environmental cues, such as molecular signals from the gut. These cues largely originate from the microbiome, the consortium of symbiotic bacteria that reside within all animals. Research over the past few years reveals that the gut microbiome plays a role in basic neurogenerative processes such as the formation of the blood-brain barrier, myelination, neurogenesis, and microglia maturation and also modulates many aspects of animal behavior.”
I genuinely believe we are living through a medical revolution, as historically important as when “germs” were first discovered in the 1850s. I believe we will learn to fix “broken” microbiomes (more on this in future posts), and with all my heart, I hope we learn to fix the CNS damage such unhealthy biomes may have caused.
[ii] Maqsood, R. & Stone, T.W. Neurochem Res (2016) 41: 2819. doi:10.1007/s11064-016-2039-1
[iii] Gareau, M.G. (2016). Chapter Eleven – Cognitive Function and the Microbiome. International Review of Neurobiology. Volume 131, 227-246.
[iv] Sharon, G., Sampson, T.R., Geschwind, D.H., Mazmanian, S.K. (2016). The Central Nervous Ssytem and the Gut Microbiome. Cell 2016 Nov 3;167(4):915-932. doi: 10.1016/j.cell.2016.10.027.
I recently did a couple of webinars on the biome for practitioners down in Australia. In preparing my slides, I came across some amazing (and terrifying) statistics. According to the CDC in the US, 7.6% of Americans aged 12 and over have had moderate to severe depression in the past 2 weeks. In Australia, a million people a year (in a population of 23 million – so about 4%) suffer from depression. The numbers are staggering. And that is just depression! What about anxiety disorders: generalized anxiety disorder, PTSD, panic attacks, OCD (which is a subset of anxiety disorders), bipolar disorder, autism, ADHD, etc.?
Referring back yet again to Sid Baker’s spider web analogy – that everything in the body is interconnected – it is amazing how much information has been discovered in the last couple of years about the immune-CNS-gut connection. In 2015 an important article was published in the Journal of Experimental Medicine which, for the first time ever, showed that the central nervous system is physically tied in directly to the immune system via a previously unknown system of lymph vessels.[i]
Scientific America had a great summary article of this revolutionary finding:
“Perhaps the most commonly cited division between body and brain concerns the immune system. When exposed to foreign bacteria, viruses, tumors, and transplant tissue, the body stirs up a torrent of immune activity: white blood cells devour invading pathogens and burst compromised cells; antibodies tag outsiders for destruction. Except, that is, in the brain. Thought to be too vulnerable to host an onslaught of angry defensive cells, the brain was assumed to be protected from this immune cascade. However research published this month reported a previously unknown line of communication between our brains and immune systems, adding to a fast-growing body of research suggesting that the brain and body are more connected than previously thought.” [ii]
In a way though it’s strange that anyone would have ever thought the immune system was completely separate from the brain. Medicine has long recognized “sickness behavior,” for example: when an organism is sick, and inflammatory cytokines are released, the organism conserves energy to use it in the battle against the disease – thus appearing lethargic and enervated. Back in 2013, I remember reading this blog post from Harvard Health Publications, “Infection, Autoimmune Disease Linked to Depression,”[iii] which cited an amazing statistic based upon a study of the entire Danish population from 1945 to 1995: “People who had been treated for a severe infection were 62% more likely to have developed a mood disorder than those who never had one. An autoimmune disease increased the risk by 45%.”
And of course, the connection is bidirectional. How many of us have gotten sick after a period of extreme psychic stress? Shingles is a perfect example: the herpes virus that causes shingles lives in the nerves, but is generally kept dormant by our immune systems. Stress us out and suddenly, the virus wins out over our suppressed immune system.
So, what does all this have to do with the gut biome? 70% or more of our immune system is in our digestive system as most germs enter through our nose and mouth. And our body’s co-inhabitants are a crucial part of normal immunity…and also, talk directly to our brains. Completely coincidently, just before finishing this post, I read about the publication of a new article called “Linking the Human Gut Microbiome to Inflammatory Cytokine Production Capacity.”[iv] I’ll write more on this, the connection of the gut biome to brain development and health, and other recent research in the near future.
[i] Aleksanteri Aspelund, Salli Antila, Steven Proulx, Tine Karlsen, Sinem Karaman, Michael Detmar, Helge Wiig and Kari Alitalo. A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules. The Journal of Experimental Medicine, June 2015 DOI: 10.1084/jem.20142290
[iv] Schirmer, Melanie et al.Linking the Human Gut Microbiome to Inflammatory Cytokine Production Capacity. Cell , Volume 167 , Issue 4 , 1125 – 1136.e8
Every morning I read through all the latest news on the biome, both micro and macro. I am excited about the onslaught of new research looking at the gut-brain connection. As I mentioned in my previous post, this concept was the basis of my very first lesson on chronic illness. (In my case, my son’s autism was the focus.) On the other hand, I always feel a deep sense of frustration: if I was learning about this stuff 20 years ago, why is it only now that the medical establishment is REALLY paying attention?
It was just this morning that I read for the first time that the connection between the gut biome and mental health is finally so well established that scientists have given it a name: Psychobiotics.
“Now that we know that gut bacteria can speak to the brain—in ways that affect our mood, our appetite, and even our circadian rhythms—the next challenge for scientists is to control this communication. The science of psychobiotics, reviewed October 25 in Trends in Neurosciences, explores emerging strategies for planting brain-altering bacteria in the gut to provide mental benefits and the challenges ahead in understanding how such products could work for humans.”1
NOW that we know that gut bacteria can speak to the brain?! Grrrr. I was told that 2 decades ago, and it wasn’t new news then! Yes, yes, I know: science can only progress so fast. First and foremost, it’s a business – and whatever makes the most money will get the most money, in terms of funding. Secondly though, it’s also true that the human body is so unbelievably complex that it boggles the mind. Back to Sid Baker’s spider web analogy: everything in the body affects everything else. Heaven knows how many processes are occurring through the body and cells at one time, and if one tiny thing goes askew, the entire organism is tipped into imbalance – like dominoes falling. Rationally speaking, I know that inch by inch, scientific knowledge progresses.
Where does that leave us though, who are in the trenches right now, battling incredible suffering in ourselves and/or our children? “If it can’t hurt and it could help, do it,” I’ve told myself for the last 20 years. And if there’s any doubt about the “hurt” part, put the potential treatment on the risk/reward scale and see how things fall.
About 15 years ago or so, I was at an autism medical conference, and was privileged to see a talk about the gut-brain connection given by Dr. Martha Herbert. Dr. Herbert is an eminent neurologist at Harvard/Mass General, and has been a huge proponent of, as she says, “the brain being downstream from the gut.” As she concluded her talk, she acknowledged that we are in the earliest stages of understanding this connection but felt that even then, the evidence was strong enough to support families taking measures to improve the health of the gut biome to treat their children’s autistic symptoms. “When faced with prolonged scientific uncertainty,” she said, “Use your best judgement.” I quickly wrote down her exact words ensuring I would never forget them. Right there, she summed up my philosophy far more eloquently than I ever could. I’ve lived by that mantra from the day my son was first diagnosed.
But back to where science is today. Over time, I am looking forward to sharing with you whatever new information comes down the pipeline. I will also review great stuff that has appeared of the last few years. No matter who you are, whether or not you are suffering from an illness or are in perfect health and want to stay that way, trying to improve the health of the biome can’t hurt and could help.
Strange when you can look back and realize that a single moment in time was a turning point in your life. I have always loved that kind of hindsight, figuring out those exact moments that changed everything.
One was March 22, 1996, the day my 2 year old son, Alex, was diagnosed with autism. My entire world shifted on its axis. Everything I had ever done or thought, wanted or needed, liked or hated…everything became irrelevant. What mattered was helping my sick baby. (And Alex was and is SICK: idiopathic immune deficiency, seizures, and a history of inflammatory bowel disease.)
What I rapidly came to understand is that the system-model of the human body that is taught in your average 9th grade biology class (the circulatory system, the immune system, the central nervous system, etc.) is nonsense. My first teacher was Dr. Sidney Baker, one of the founders of the functional medicine movement that thankfully continues to gain traction around the world, who I first met on March 8, 1997 (at 2:00 pm EST, to be precise), just after Alex’s 3rd birthday. Another major turning point.
Sid pointed to the fake spider web he had hanging in the corner of his office and explained to me that the human body is all one thing: like that spider web, everything is intertwined…and no part of the body works in isolation. Sid went on to explain that autism is a set of symptoms that results from alterations in the immune system and in the biome of the gut…
The what of the gut?
The biome: all the living organisms in an ecosystem. And the human body is an ecosystem, teeming with life. Like all ecosystems, we have our non-living matter (for example, water) and living matter, like our own cells and the trillions of co-inhabitants that live in and on us.
As time passed and I learned more, I truly came to understand what Sid meant. More and more research began to demonstrate alterations in normal gut flora being suspect in the origin of autism…and other chronic illnesses ranging from obesity to celiac disease to depression. Then, in 1999, I read an article in the NY Times (“In Pursuit of Autoimmune Worm Cure,” by Andy Newman) which explained the work of Dr. Joel Weinstock who used helminths – the native animal life inhabiting the guts of all mammals on this planet, except those of us in the industrialized world – to treat inflammatory bowel disease. Dr. Weinstock hypothesized that by adding back our missing macrobiome, he could stimulate the immune system in such a way as to reduce autoimmunity and inflammation. Sure enough, 6 of the 7 individuals in the study went into remission and the 7th also improved dramatically.
The article rocked my world.
It was at that moment, reading that article, that what had been a mere interest in the human biome became an obsession.
In 2013 I co-founded Biome Restoration Ltd., a UK company that provides those helminths (more on this in future posts). I turned my hobby into my profession: it’s the old “love what you do and you’ll never do a day’s work” adage come to life. Yes, as my big brother mutters when introducing me, “My sister sells worms.”
So, here I am, so many years later, still daily reading whatever I can find (which is now an incredible amount) on the wonderful and amazing biome and its relationship to health. Trendsetter that I am, it seems like pretty much everyone else in the world has finally figured out that this is where it’s all happening – deep down in our digestive systems, where the majority of our old friends live.
Our biome is what’s trending.