THE BRAIN / GUT CONNECTION IN RELATIONSHIP TO DEPRESSION, ANXIETY, AND CHRONIC STRESS
As defined by the government's NIH website, Anxiety (aka 'Panic Disorder'), which amazingly is said to affect over 18% of the population, "is a real illness... characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control."
According to the same website, Depression, "is one of the most common mental disorders in the United States. An estimated 16 million adults aged 18 or older in the U.S. had at least one major depressive episode in the past year, with women being 70 % more likely than men to experience depression during their lifetime." Many would say this incidence of 7% is far too low. For instance, the CDC puts the incidence of Depression at 9%. Even the NIH's NMIH seems to contradict itself by revealing that, "A report tracking antidepressant use among Americans from 2005-2008 found that more than 1 in 10 Americans ages 12 and older report taking an antidepressant medication." If you add CHRONIC PAIN, TRAUMA, or CHRONIC INFLAMMATORY DISEASES to the mix (DEPRESSION ITSELF is considered "Inflammatory") ---- issues that doctors commonly prescribe Antidepressants for --- the numbers are staggering.
By far, the most common medical approach to treating DEPRESSION involves prescribing ANTIDEPRESSANTS. Not only are there any number of problems and side-effects with this class of drug, but according to research, they frequently do not work. The blog post (Antidepressants: A Complicated Picture) of NMIH director, Dr. Thomas Insel, carried some telling statistics regarding this little known fact.
"Mild depression tends to improve on placebo so that the difference between antidepressant use and placebo effect is very small, or at times, absent. In more severe forms of depression, antidepressants show greater efficacy. It is important to note that these clinical studies have primarily focused on reducing the symptoms of depression and not on a broader range of potential outcomes (such as changes in everyday functions, cognitive abilities, quality of life, etc.). In addition, because clinical trials are conducted in a controlled environment, they do not necessarily reflect the way actual clinical practice operates. And even under research conditions, clinical trials for antidepressants use rating scales that may be weak or imprecise indicators of efficacy."
Truthfully, this sounds like a whole lot of beating around the bush. This sort of mumbo jumbo begs the question of how effective Antidepressant Drugs really are. Wait no more because Insel reveals this information later in his post. Near the end of the post he states that, "The bottom line is that these medications appear to have a relatively small effect in patients broadly classified as having depression." Wait; that's more mumbo jumbo. Insel is referring to a 2008 meta-analysis published in PLoS Medicine (Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration) that hac this to say...... (To read more about "UNPUBLISHED STUDIES", you can follow this link or click the previous link above)
"Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance.... Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication."
How's that for EVIDENCE-BASED MEDICINE? Am I the only one who finds it appalling that one of the biggest and most lucrative segments of the DRUG INDUSTRY is built on lies and outright fraud? The good news is that there are things you can do to help heal your brain. The starting point is to realize that your GUT ACTS AS A SECOND BRAIN, and that there is an intimate relationship between your health and your MICROBIOME (the type and number of bacteria living inside of you). Anything that throws these ratios of bacteria off (ANTIBIOTICS, MEDICATIONS IN GENERAL, or even TOO MANY VITAMINS OR PROBIOTICS) can foul the Microbiome, leaving one susceptible to any number of health problems, as 80% OF YOUR ENTIRE IMMUNE SYSTEM is found in the Gut. This is why GUT HEALTH is imperative as far as overall health is concerned (HERE).
One of the things we already know from the peer-reviewed research is that people with Depression typically have issues with their Microbiome (HERE). But it doesn't stop there. Any number of forms of stress, including Separation from one's mother, are also known to cause problems in this area (Maternal Separation as a Model of Brain-Gut Axis Dysfunction).
This Irish study, performed at the Alimentary Pharmabiotic Centre of the University College Cork, concluded that, "Early life stress has been implicated in many psychiatric disorders ranging from depression to anxiety. Essential aspects of the brain-gut axis include spinal pathways, the hypothalamic pituitary adrenal axis, the immune system, as well as the enteric microbiota. Accumulating evidence suggest that stress, especially in early life, is a predisposing factor to IBS. The separated individual is characterised by alterations of the intestinal barrier function, altered balance in enteric microflora, exaggerated stress response and visceral hypersensitivity, which are all evident in IBS.; Thus, maternally separated animals are an excellent model of brain-gut axis dysfunction for the study of disorders such as IBS and for the development of novel therapeutic interventions." In other words, stressful events that occur in the very young, can foul the Microbiome (enteric microflora) causing problems such as IBS, Hypersensitivity Reactions (GLUTEN could certainly fall into this category), LEAKY GUT SYNDROME (altered intestinal barrier function), ADRENAL FATIGUE, DIABETES, and HYPOTHALAMUS DYSFUNCTION.
A study from the March, 2011 issue of Brain, Behavior, and Immunity (Exposure to a Social Stressor Alters the Structure of the Intestinal Microbiota: Implications for Stressor-Induced Immunomodulation) revealed a similar link later in life. Some of the things we learned from this study include...
In yet another similar study (this one published in the October, 2012 issue of PLoS One) called
Gut Microbiota Composition Is Correlated to Grid Floor Induced Stress and Behavior in the BALB/c Mouse, researcher found some similar features concerning stressed out mice. When mice were put through "stressful" events such as being exposed to noxious stimuli, being hung by their tails, or others, there were changes in their Microbiomes. Links from my site are added into the conclusions.
"From birth the mammalian gut slowly gets inhabited with a wide range of bacteria that primes the cells of the immune system during the postnatal period [HERE]. Throughout life, the gut microbiota (GM) remain an important factor in development of diseases, such as inflammatory bowel diseases, asthma/allergy, colon cancer, type 1 diabetes, HIV and obesity [HERE, HERE, HERE, HERE, HERE, and HERE]. It is evident that diseases of both body and mind worsen in response to stress, and interest in the so-called gut-brain axis consisting of neural, immune and endocrine pathways has increased, e.g. due to clinical experience with patients suffering from irritable bowel syndrome (IBS), in which a higher incidence of psychiatric illness has been acknowledged [HERE]."
What's truly mind-bending is that this study goes on to talk about the relationship between certain kinds of diseases and INFLAMMATORY HEALTH PROBLEMS, also spending significant time dealing with the fact that when certain kinds of bacteria are added back to the ill host (often via FECAL MICROBIOTA TRANSPLANT --- FMT) disease symptoms and inflammatory sequelae are alleviated or eliminated. Although PROBIOTICS are never as good as FMT (HERE), we have a great deal of evidence that Probiotics can at the very least, make a beneficial difference. Allow me to show you some studies.
The March, 2009 issue of Gut Pathology carried a study (A Randomized, Double-Blind, Placebo-Controlled Pilot Study of a Probiotic in Emotional Symptoms of Chronic Fatigue Syndrome) which had some interesting tidbits on the topic. "Chronic fatigue syndrome (CFS) is complex illness of unknown etiology. Among the broad range of symptoms, many patients report disturbances in the emotional realm, the most frequent of which is anxiety. Research shows that patients with CFS and other so-called functional somatic disorders have alterations in the intestinal microbial flora. Emerging studies have suggested that pathogenic and non-pathogenic gut bacteria might influence mood-related symptoms and even behavior in animals and humans. In this pilot study, 39 CFS patients were randomized to receive either 24 billion colony forming units of Lactobacillus casei strain Shirota (LcS) or a placebo daily for two months. Patients provided stool samples and completed the Beck Depression and Beck Anxiety Inventories before and after the intervention. We found a significant rise in both Lactobacillus and Bifidobacteria in those taking the LcS, and there was also a significant decrease in anxiety symptoms among those taking the probiotic vs controls"
A couple years later, the March, 2011 issue of the British Journal of Nutrition published a study called, Assessment of Psychotropic-Like Properties of a Probiotic Formulation (Lactobacillus Helveticus and Bifidobacterium Longum) in Rats and Human Subjects. After the authors admitted that this concoction works well for relieving GI discomfort, they state that, "Emerging evidence of a role for gut microbiota on central nervous system functions therefore suggests that oral intake of probiotics may have beneficial consequences on mood and psychological distress. In the clinical trial, volunteers participated in a double-blind, placebo-controlled, randomised parallel group study with PF (Probiotic Formulation) administered for 30 days and then assessed with.... Daily subchronic administration of PF significantly reduced anxiety-like behaviour in rats and alleviated psychological distress in volunteers."
Within a few short months, the July, 2011 issue of Gut Microbes gave us the study, Beneficial Psychological Effects of a Probiotic Formulation in Healthy Human Volunteers. This study revealed that, "In a recent clinical study, we demonstrated in the general population that Lactobacillus helveticus and Bifidobacterium longum (PF) taken in combination for 30 days decreased the global scores of hospital anxiety and depression scale, and the global severity index of the Hopkins symptoms checklist, due to the decrease of the sub-scores of somatization, depression and anger-hostility spheres in human volunteers. The data show that PF improves the same scores as in the general population i.e. SOMATIZATION [mentioned in the previous study as well], depression and anger-hostility), as well as the PSs score and three other sub-scores of the HSCL-90, i.e. "obsessive compulsive", "anxiety", and "paranoid-ideation". Moreover, the score is significantly improved over time in PF-treated subjects compared with controls."
Less than two years later, the March, 2013 issue of Gastroenterology (Consumption of Fermented Milk Product With Probiotic Modulates Brain Activity) kept the ball rolling by studying whether or not one month of consuming Fermented Milk Products with Probiotics (FMPP) would make changes in the Functional MRI'S of certain parts of subject's brains. "FMPP intake was associated with reduced task-related response of a distributed functional network containing affective, viscerosensory, and somatosensory cortices. Alterations in intrinsic activity of resting brain indicated that ingestion of FMPP was associated with changes in midbrain connectivity, which could explain the observed differences in activity during the task. Four-week intake of an FMPP by healthy women affected activity of brain regions that control central processing of emotion and sensation." So; not only did the Probiotics affect behavior, they affected an MRI as well ---- after only one month.
The December, 2014 study (Prebiotic Intake Reduces the Waking Cortisol Response and Alters Emotional Bias in Healthy Volunteers), published in the journal Psychopharmacology had some interesting things to say about feeding these bacteria. "We have recently demonstrated that prebiotics (soluble fibres that augment the growth of indigenous microbiota) have significant neurobiological effects in rats. Forty-five healthy volunteers received one of two prebiotics (fructooligosaccharides, FOS, or galactooligosaccharides, B-GOS) or a placebo (maltodextrin) daily for 3 weeks. The salivary cortisol awakening response was significantly lower after B-GOS intake compared with placebo. Participants also showed decreased attentional vigilance to negative versus positive information after B-GOS compared to placebo intake."
And just last month, the journal Brain, Behavior, and Immunity published a study called Altered Fecal Microbiota Composition in Patients with Major Depressive Disorder. In the same way that doctors are looking for BLOOD BIOMARKERS IN PEOPLE WITH TBI (as opposed to doing MRI's that all too often come back negative), this study was trying to determine if fecal bacteria could be used as a biomarker for Depression. Here are the 'cherry picked' results. "Studies using animal models have shown that depression affects the stability of the microbiota. We analyzed fecal samples from 46 patients with depression and 30 healthy controls. Increased fecal bacterial diversity was found in the Depression vs. the control group. A negative correlation was observed between Faecalibacterium and the severity of depressive symptoms." In other words, the more Faecalbacterium, the less Depression.
PRACTICAL USE OF THIS POST
We've just learned that Gut Health is a huge factor in mental health. The outrageous thing about these types of studies is that they are going on with almost every sort of disease you can imagine (HERE is an example with Multiple Sclerosis). In other words, it's not simply a "Depression" issue. My best advice to you concerning ways to fix your Gut would not include living your same lifestyle, and simply taking more Probiotics --- something that the majority of the people reading this post will try (if they try anything at all). What do I recommend? Besides fixing your "barriers" (Leaky Gut Syndrome, aka Increased Intestinal Permeability), these recommendations constitute a starting point.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).