Stress Psychiatry and the Intestinal Microbiome
October 4th, 2021
Over a few upcoming podcasts we are going to take a deep dive with a few experts in the gut health space. In preparation for these discussions, I am going to highlight some of the literature on the related issues like this week:
Humans develop disease from many different routes including toxic exposures, genetics, poor nutrition, injury, microbial exposures and much more. One of the biggest risk factors for the development of disease is mental stress. Specifically, chronic stress of the psyche is traumatic to the cellular machinery of the body like the protective telomere tails of DNA strands or the functioning intestinal microbiome.
What I find fascinating is that stress, the brain, and the microbiome are intimately linked. In this article, we are going to look at the this association and what we can do to positively support it. The gut is often called the second brain and that is not by accident as there is a large network of nerves throughout our gut called the enteric nervous system. This is thought to be why we can have a "gut reaction". Roughly 80-90% of the bodies supply of the neurotransmitter serotonin resides in the gut. The functions of serotonin include regulating mood, sleep, appetite, gut motility and various cognitive functions.
Why would such an important neurotransmitter be concentrated in the gut? My medical school professors taught me to believe that the intestine is a place of digestion and assimilation, not thinking and feeling.
It turns out that the fields of neurology, epigenetics and microbiology are working together to answer this question and change the narrative.
What we now know to be true is that there is a bidirectional flow of communication that uses neural, hormonal and immune routes to achieve the goal of bridging the worlds of the brain, our bacterial friends and the rest of our sensing and feeling body. This is called the gut-brain axis. (Cryan et. al. 2012) What is even more astounding is that the microbes that reside in our intestines have direct and profound effects on how our brain works. (Mayer et. al. 2014) Evidence continues to accumulate that bacteria and viruses that live within us have elegant ways of hijacking our neurological system and changing who we are and how we feel.
Whether it is autism spectrum disorders, anxiety, depression or chronic pain, a significant portion of the cause can now be attributed to the gut microbiome. I am a believer that the autism spectrum disorders, in part, will be shown to be a result of insults to the maternal fetus dyad via epigenetic alterations, autoimmunity and microbial imbalances in the gut and brain.
To keep this clear of the leap of faith world, let us look at a few studies. In 2017, Dr. Sangdoo Kim and her team showed that mice with abnormal bacterial signatures in their intestinal microbiome birthed offspring with autism like features. This effect could be prevented by treating the animals with antibiotics and killing these pathogenic bacterial species. (Kim et. al. 2017) This is important as we will discuss in upcoming podcasts because of the fact that the microbiome of a newborn reflects that of a mother in the first trimester of pregnancy. (Koren et. al. 2012) Thus, if a mother's intestinal microbiome is dysfunctional preconception, then the child will follow suit based on the science. The microbes that colonize the newborn's intestinal tract could and likely are dysfunctional in many children prone to neurological disease. Which is the chicken and which is the egg remains to be seen.
Further studies have shown that restoration of intestinal microbes via probiotic therapy or fecal transplantation can ameliorate the anxiety burden. (Mayer et. al. 2017) Collins and colleagues showed that anxiety could be induced by transplanting the bacteria from an anxious mouse to a happy mouse. (Collins et. al. 2013) The strain of probiotic known as Lactobacillus which is commonly found in over the counter probiotics can increase the receptor for GABA, a calming neurotransmitter, which in turn reduces anxiety and depressive type behaviors. (Bravo et. al. 2011)
In an upcoming podcast with Dr. Tracy Shafizadeh, we discuss the product Evivo, a probiotic based on a specific Bifidobacter infantis subspecies that has 19 genes to digest all of mom's HMO's or human milk oligosaccharides, sugars, in her breastmilk to help establish a normal and functional microbiome. When a mother and her newborn are missing this bacteria, then the child cannot adequately digest 15% of mother's milk. The real issue at play here is that the digestion of the HMO's causes a metabolic effect locally feeding the infant's gut cells called enterocytes and ultimately polarizing the neonatal immune system to natural tolerance of foods and substances while remaining vigilant to pathogens. Their scientific discovery is excellent. The reason that I raise this topic here is that I think that we will learn that these missing microbes coupled to SAD diets are driving this neurological phenotype in mother's and their children. Ok, moving on.
There is a large body of evidence that chronic stress can alter the microbes in the gut, disrupt the intestinal barrier leading to food reactions, increased immune activation and changes in our behavior. (Cryan et. al. 2012)
Pausing here to recap some hard science, we have a clear picture that the world of psychiatry and neurology used to believe that depression, anxiety and other neurobehavioral disorders were hard wired genetic defects or broken brain chemistry. This could not be farther from the truth!
The intestinal microbiome and the bacteria within play a large role in human mental health. The scientific evidence is clear that we need to prevent damage to the microbiome and stop altering the bacteria within negatively.
What I know to be true now is that psychiatric and neurobehavioral disorders are NOT the effects of broken brains in the vast majority of cases. They are NOT the effects of choice for many people in the beginning of the disease genesis. They are NOT hardwired and permanent. Even poorly treated and previously thought irreversible diseases like Alzheimers dementia are NOT so if caught early enough before massive tissue damage occurs. The groundbreaking scientific work of Moshe Szif (nature versus nurture), Dale Bredesen (Alzheimers reversal specialist) and Terry Wahls (Multiple sclerosis reversal) have opened a locked door to a whole new world of hope and understanding for resolution of devastation to the brain.
What these pioneers are doing is rewriting medicine by not accepting the current status of disease etiology and instead starting from the roots of the tree to find the breakpoint that began the disease. They are working on patients microbiomes through diet alterations, working on brain pathways through epigenetics via stress reduction training and so much more.
How does mental stress play into this reality?
Most forms of stress in the acute phase are often life extending as they elaborate cassettes of genes in our DNA that are hanging out in order to come to play when life gets difficult. I think of temperature shock protein genes here. They are there to preserve our species and help us procreate, our two main driving forces of existence. Where stress becomes an issue is in the chronic unremitting state. Study after study has shown that this persistence of stress breaks down all levels of our neural, hormonal and immunological communication pathways. We all know this to be true as we often get ill with infectious organisms following a prolonged stressful event.
If we accept that the microbiome is affected by stress and the microbiome in turn affects our mood and cognition, then it behooves us to pay particular attention to what disturbs the microbiome and thus our psyche as well.
Here I think of perception of events versus the reality of an event. Perception can drive a negative state of physiological function that then feeds forward into a diseased feeling further reinforcing a loop of negativity. The podcast released yesterday with Dr. David Rakel is exactly the kind of education that we all need. We need to understand that we have choices, we have routes to health and healing, we have the ability to change our perception of anything.
Give the podcast a listen as he is an amazing teacher.
As always, I have a roadmap below that many of you have seen many times. I repeat it over and over again for all of the new readers and learners.
How does a young person, mother or a mother's future offspring protect their microbiome from perturbation and disease while maintaining a healthy mind?
1) CRITICAL - Avoid all antibiotics, antacids and non steroidal anti inflammatory drugs where possible before becoming pregnant and during pregnancy as well. These drugs and many others adversely effect the healthy gut microbes.
2) CRITICAL - Eat a predominantly plant based whole foods diet like Dr. Weil's anti-inflammatory diet. This means shunning flour and sugary "white" foods. Fermented foods like kefir, kimchi, kombucha, yogurt and sauerkraut are direct bacterial sources for the gut. Avoid all refined and processed foods that are low fiber, high bad fat and sugar bombs.
3) Avoid non nutritive sweeteners like saccharin, aspartame and sucralose which promote the growth of unhealthy bacteria.
4) Avoid endocrine disrupting chemicals, EDC. See the newsletter on EDC's below. Visit www.ewg.org for lists of chemicals to avoid. Go old school with plain soap and vinegar as disinfectants. Targeted diluted bleach for raw animal based food residue on countertops in the kitchen is useful.
5) Consider taking high quality probiotics in the range of a 100 billion bugs. (only with the advice of your provider.) If you have a newborn, look into Evivo for a healthy first year of life.
6) Eat local organic foods until we have definitive proof that round up/glyphosate and other chemicals in our food supply are truly safe. The early research on these chemicals and the microbiome are not encouraging.
7) CRITICAL - Meditate and reduce stress daily. Get into a rhythm of daily gratitude and prayer to engender a mindset of happiness no matter where you find yourself or how much external stress is pushing on you. Avoid negativity in all its forms. Negative mind sets only promote stress and stagnation of spirit.
8) Consider an elimination diet if you are suffering from chronic fatigue, gut bloating/irritable bowel syndrome, chronic headaches or other somatic symptoms of food reactivity. Removing trigger foods can stop food gut induced inflammation that can damage the microbiome. Trials of 1 to 2 months off of offending foods often answers the question for you as your body will feel dramatically different if you have a food sensitivity. Eliminating Gluten, dairy, corn, egg, soy, tree nuts, peanuts and shellfish accounts for most food reactions that are not anaphylactic and classified as allergy/sensitivity. Never try elimination re-challenge diets with foods that cause anaphylactic symptoms like vomiting, wheezing, oral swelling, loss of blood pressure. See this website if your are unsure of your reaction. Seek expert help when working on elimination diets.
9) Consider taking a prebiotic supplement to enhance the growth of the good bacteria that you already have. Great in smoothies and cold beverages. I love Bob's Red Mill's unmodified potato starch, an excellent resistant starch prebiotic.
10) Exercise daily to a sweat. Enhances microbial quality and helps the body rid itself of toxins.
11) If you are really struggling with gut health despite trying the above recommendations, find a functional/integrative medicine or gastroenterologist practitioner versed in analyzing the intestinal microbiome to assess for overgrowth of bad bacteria or yeast. Treatments for these problems are very specific and complicated.
12) Get adequate sleep to reduce stress.
13) CRITICAL - Aim for a vaginal delivery every time. No scheduled cesarean sections unless medically indicated.
14) CRITICAL - Breastfeed exclusively until 6 months. I recommend whole foods for your baby from 6 months on. No white refined foods.
15) Finally, anything that you perceive as chronic stress is a real stressor for you. You must change the narrative in your mind that this is a problem. Accept the current reality until you can remove yourself from the stressor or mitigate it somehow. Jesus Christ and the philosopher stoics understood this philosophy well. Turning the other cheek, forgiveness, boundaries, standing strong in the storm, whatever you want to call it, will help you maintain a reduced stress life. We will always have stress. Our perception and reaction to the stress dictates our physiologic outcome!
To a healthy gut microbiome
Cryan Nature Reviews Article
Mayer Journal of Neuroscience Article
Kim Nature Article
Nuriel-Ohayon Frontiers in Microbiology
Collins Current Opinions in Microbiology
Bravo PNAS Article
Newsletter on Autism
Endocrine Disruptors Newsletter
AAAAI Food Allergy Site