Mental health and gut microbes
Journal of Neuroscience:
The discovery of the size and complexity of the human microbiome has resulted in an ongoing reevaluation of many concepts of health and disease, including diseases affecting the central nervous sytem. A growing body of preclinical literature has demonstrated bidirectional signaling between the brain and the gut microbiome, involving multiple neurocrine and endocrine signaling mechanisms.
While psychological and physical stressors can affect the composition and metabolic activity of the gut microbiota, experimental changes to the gut microbiome can affect emotional behavior and related brain systems. These findings have resulted in speculation that alterations in the gut microbiome may play a pathophysiological role in human brain diseases, including autism spectrum disorder, anxiety, depression, and chronic pain. 1
The Bowel and Mental Health
“A priority clinical and research agenda in mood and anxiety disorders is to identify determinants that influence illness trajectory and outcome. Over the past decade, studies have demonstrated a bidirectional relationship between the gut microbiome and brain function (i.e., the micribiota-gut-brain axis). Probiotic treatments and developmental analysis of the microbiome may provide potential treatments and preventative measures for depressive and anxiety disorders.”2
The Bowel Has a Mind of Its Own
The bowel has a brain of its own. It comprises an enormous network of neurons (nerve cells) and nerve fibers. The brain cells of the gut forever engage in vigorous cellular cross-talk—adding layers of complexity to functionalities of the bowel. There is an elegant simplicity of design for the local control of local affairs—autoregulation, in my language. Simply stated, a population of specialized cells (interneurons) provides both the hardware and software for the “bowel-wide web.” The bowel also has a mind of its own. It listens to the brain but only up to a point. When the chips are down, it prefers to listen to its own voice—and works by its own design and instinct. Psychiatrists are fond of prescribing drugs that alter the function of serotonin—Prozac and Paxil, for instance—to treat depression. They do not consider the fact that nearly 95% of serotonin production in the body occurs in the alimentary tract. This is one of the scientific facts that explains my clinical findings:
- the brain function cannot be optimized without addressing toxicities of the environment, foods, and thoughts; and
- the issues of toxicities cannot be addressed without restoring bowel ecology.
Probiotics and Mental Health
IBS and Stress
For those with irritable bowel syndrome who wonder if stress aggravates their intestinal disorder, a recent University of Michigan Health System study shows it’s not all in their head.
According to the researchers stress does not cause IBS, but their study revealed it does alter brain-gut interactions and induces the intestinal inflammation that often leads to severe or chronic belly pain, loss of appetite and diarrhea.
Stress has a way of suppressing an important component called an inflammasome which is needed to maintain normal gut microbiota, but probiotics reversed the effect in animal models, according to findings published in Gastroenterology. 3
Probiotics and Depression
Read this material from Biological Psychiatry about a recent study:
Over the past few years, studies have been undertaken to explore the possible impact of probiotics on behavior. It is within this context that the concept of a psychobiotic has arisen.
The authors of a (recent) review article in Biological Psychiatry, Timothy Dinan and his colleagues from University College Cork in Ireland, define a psychobiotic as “a live organism that, when ingested in adequate amounts, produces a health benefit in patients suffering from psychiatric illness.”
They review the evidence that these bacteria, when ingested in adequate amounts, offer enormous potential for the treatment of depression and other stress-related disorders.
The gut microbiota, which contains approximately 1 kg of bacteria, can be modulated by diet and many other factors. It is not static and can change from day to day, starting at birth. Evidence has shown that even the form of delivery (vaginal versus cesarean) alters an individual’s microbiota.
Probiotics have the potential to exert behavioral and immunological effects.
Early life stress, such as maternal separation, is known to induce long-term changes in the microbiome. Dinan and his colleagues review one study that assessed the potential benefits of a specific probiotic, B. infantis, in rats displaying depressive behavior due to maternal separation. The probiotic treatment normalized both their behavior and their previously-abnormal immune response. This preclinical study and others like it strongly support the hypothesis that probiotics have the potential to exert behavioral and immunological effects.
Some psychobiotics have been shown to have anti-inflammatory effects. This is important because depression and stress are both associated with inflammation in the body. Infectious diseases, such as syphilis and lyme disease, can also produce depressive states. Evidence suggests that immune activations, perhaps via psychobiotic action, could alleviate such states. According to the authors, “the intestinal microbial balance may alter the regulation of inflammatory responses and in so doing, may be involved in the modulation of mood and behavior.”
Those who received the probiotics reported lower stress levels
Human studies are still largely lacking, but a few have shown promising results. In one, healthy volunteers received either a probiotic combination (L. helveticus R0052 and B. longum) or placebo for 30 days. Those who received the probiotics reported lower stress levels. In a separate study, volunteers who consumed a yogurt containing probiotics reported improved mood.
“What is clear at this point is that, of the large number of putative probiotics, only a small percentage have an impact on behaviour and may qualify as psychobiotics,” said Dinan.
“This intriguing new area of research may open new possibilities for the treatment of depression,” said Dr. John Krystal, Editor of Biological Psychiatry.
For now, we must all wait for scientists to conduct large-scale, placebo-controlled trials to provide definitive evidence. 4
Human molecular defenses exist as plants in the soil of the bowel content. In The Canary and Chronic Fatigue, (1994), I wrote these words to simply state my primary conclusion derived from decades of clinical and pathological work with the bowel. Year after year, I observed the same phenomenon: Chronically ill patients have severely disrupted bowel ecosystems and they do regain their health until that system is restored-assiduously with a broad-based integrative seed-feed-and-occasionally-weed approach.
Human antioxidant and immune defenses are plants rooted in the soil of the bowel contents. The bowel ecosystem is as diverse and delicate as any other in nature. It interfaces with the outside world on one side and with the blood ecosystem on the other. The blood ecology, in turn, integrates with liver, kidney and brain ecosystems. Human health, in essence, is a dynamic ecologic equilibrium among the various body organ ecosystems.
Few things are as distressing as seeing little children who live on antibiotics. In so doing, food and mold allergies that set them up for recurrent infections go unrecognized. Their delicate bowel ecosystems are battered repeatedly with broad-spectrum antibiotics that violate their antioxidant defenses. When their oxidative metabolism causes behavior and learning difficulties, school psychologists promptly label them with hyperactivity and attention deficit disorders, or refer them to their pediatricians who readily oblige the psychologists with Ritalin prescriptions.
Many women suffering from severely battered vaginal and urinary ecosystems are prescribed one course of antibiotics after another. The symptoms caused by such ecologic disruptions are vigorously suppressed with yet additional doctors. Not infrequently, they are completely unaware of the true nature of their suffering. Attempts to resolve issues of stress with therapies based on the prevailing—and simplistic—fight-or-flight notion of stress are bound to fail, and they do.
Similarly, there are important ecologic considerations affecting home and work environments.
Since health is ecologic equilibrium, it can only be preserved with ecologic thinking. Until mainstream physicians learn to think ecologically, people who suffer chronic stress have no choice but to learn about ecologic balances in the body and how to preserve them.
The Seed-Feed-and-Occasionally-Weed-Way to Reverse Chronic Inflammatory, Immune, and Infectious Diseases
Seeding is the repopulation of the gut with microflora that have been destroyed by indiscriminate use of antibiotics or crowded out by the unrestrained proliferation of yeast and bacterial organisms such as the Proteus and Pseudomonas species. The “guardian angel bacteria” for bowel ecology belong to the Bifidobacterium and Lactobacillus species. Some other species also play protective roles. In health, these organisms provide the necessary counterbalance to the growth of yeast and pathogenic bacterial organisms. Beyond this, these organisms produce several molecules that play critical roles in our molecular defense systems.
Feeding is the use of some growth factors that the normal bowel flora require to flourish. These include biotin, pantetheine, Vitamin B12 and others. We clinicians have used Vitamin B12 for decades with good clinical results (to the great chagrin of those “academicians” who considered it quackery because they couldn’t understand how this vitamin could ever help anybody except those with pernicious anemia). One of the principal mechanisms by which vitamin B12 exerts its myriad beneficial effects is by serving as a “growth hormone” for health-preserving bowel flora. Of course, this vitamin has several other essential roles. It plays a role in the citric acid cycle (the main molecular pathway for energy generation where it facilitates the conversion of methylmalonyl-CoA to succinyl-CoA) and is essential for cell maturation. Further, Vitamin B12 benefits many patients with neuropsychiatric disorders unassociated with anemia or macrocytosis (N Eng J Med 318:1720; 1988).
Occasional weeding is the use of several natural substances that are known to suppress the overgrowth of pathogenic bacteria, viruses and yeasts. During initial treatment, I frequently use oral nystatin or fluoconazole (Diflucan) for short periods of two to three weeks, partly for diagnostic and partly for therapeutic reasons (how a person with one of the ABE states responds to these agents is useful in assessing the degree of damage to bowel ecology). Extensive clinical experience has convinced me that long-term clinical results are far superior when the use of drugs is kept to a minimum.
Nystatin To Support The Seed-Feed-and-Occasionally-Weed-Way
I find judicious and intermittent use of Nystatin (an antifungal not absorbed from the gut) to be extremely valuable in controlling excessive fermentation in the colon, small intestine, stomach, esophagus, and the oral cavity.
Simple-minded efforts to “get rid of the yeast” with nystatin and “yeast-free diets” usually yield poor long-term results. Cold hands are associated with “cold bowel.” Cold hands and cold bowel are the result of oxidatively-damaged thyroid enzymes (underactive thyroid gland), oxidatively-damaged autonomic nerve cells and fibers (dysautonomia) or an oxidatively- overdriven adrenalin gland (the relentless chatter of the cortical monkey). None of these problems can be effectively managed with yeast-free diets and Nystatin. Of course, there are other essential issues of nutrition, environment, food and mold allergy, and fitness. In the management of battered bowel ecosystems, it is essential to consider the biologic individuality of the patient. It is necessary to adopt an integrated, long-term approach that addresses all relevant issues of bowel flora and parasites, bowel transit time, bowel ischemic patterns, IgE- mediated disorders related to Candida and other yeast antigens, malabsorptive dysfunctions, and secondary systemic consequences.
1. Mayer EA, Knight R, Mazmanian SK, Cryan JF, Tillisch K. Gut microbes and the brain: paradigm shift in neuroscience. J Neurosci. 2014 Nov 12;34(46):15490-6. doi: 10.1523/JNEUROSCI.3299-14.2014.
2. Slyepchenko A, Carvalho AF, Cha DS, Kasper S, McIntyre RS. Gut Emotions – Mechanisms of Action of Probiotics as Novel Therapeutic Targets for Depression and Anxiety Disorders. CNS Neurol Disord Drug Targets. 2014 Nov 30. [Epub ahead of print]
3. Probiotics reduce stress-induced intestinal flare-ups.
4. Are Probiotics a Promising Treatment Strategy for Depression?
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