How Do Stress, Emotion, and Diet Affect the Gut?

Stress, Emotion, Diet and the Gut

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photo by Shira Gal

The Gut – Brain Connection

It has becoming more accepted in the psychiatric literature as well as in the functional medicine that there is a bidirectional connection between the brain (central nervous system) and the gut (the gastrointestinal tract) through endocrine pathways.

Stress Affects The Gut

Stressors of various nature, either psychological or physiological, can alter the gut microbiota’s composition and the changes in the microbiota, represented through metabolic activities can influence the brain response.1

Emotion and the Limbic System

The limbic system plays a central role in regulating emotion and also is the center of the gut control.2 The generation of emotions and attached physiological reactions are most likely generated at this brain level (a very primitive part of the brain).

Depression and The Gut

In more recent scientific communications it has been suggested that depression can promote intestinal permeability as a result of chronic inflammation leading to a condition known as ‘leaky gut’. Leaky gut is another name for intestinal hyper-permeability that allows different substances (such as toxins, microbes and undigested food particles) to pass into the blood stream.

Diet and the Gut

Diet plays an important role in addressing the condition, such as ingestion of probiotics and prebiotics. Probiotics are beneficial forms of gut bacteria that helps the intestine to function properly. Examples of probiotic foods include: yogurt, kefir, sauerkraut, dark chocolate, microalgae, miso soup, pickles, tempeh (made from soy, a great source of vitamin B12 too), kimchi (an Asian form of pickled sauerkraut), Kombucha (fermented tea). For those who don’t find any of these appealing, tablets of probiotics are also good.

Prebiotics and the Gut

The prebiotics are enzymes that help the good bacteria to grow in the intestine. They are found in asparagus, Jerusalem artichokes, bananas, garlic, onions, oatmeal and legumes. They are also available in forms of supplements.

Non-Celiac Gluten Sensitivity

Another source of interest in affective disorders as well as in autism, and schizophrenia has been the Non-Celiac Gluten sensitivity (NCGS). The literature and studies are limited on the subject but it has been suggested that there is a relationship between the NCGS and neuropsychiatric disorders. Some studies point at the inflammation triggered by the gliadin in people sensitive to it and the ‘leaky gut syndrome’ associated with it.  The IgA detected in affected individuals suggest an inflammatory response to the gliadin that is found in wheat, barley, rice, and an exclusion of these products could reduce the neuropsychiatric symptoms associated with the “leaky gut” (migraines, Irritable Bowel syndrome, tiredness, chronic fatigue, etc).3

Listen To Your Body

Because research on diet and gut is still in it’s infancy it is important that you monitor how you feel after you eat certain foods. Obviously, if a food makes you feel bad you can reduce or eliminate it and see how you feel.

Integrative Treatment in Psychiatry

We take an integrative treatment approach with all our clients because we believe that any treatment that we recommend should be based on a very thorough history, questionnaires, targeted laboratory testing, and results from a physical exam.

Examples of core imbalances we assess for include:

  • Structural, boundary, and membrane imbalances
  • Genetic Mutations
  • Psychological and Spiritual
  • Hormonal and neurotransmitter imbalances
  • Oxidation-reduction imbalances and mitochondrial dysfunction
  • Detoxification, neurotoxicity, and biotransformation imbalances
  • Immune imbalances (Cytokine hypothesis)
  • Inflammatory imbalances
  • Digestive, absorptive, and microbiological imbalances

If you like this article on How Do Stress, Emotion, and Diet Affect the Gut, or have questions, schedule your first session by calling us at 713.426.3100

 

References:

1 Inflammation:Depression Fans and Flames and Feasts on the Heat: Kiecolt-Glase PhD, and colab, Am J Psychiatry, 172:11, November 2015, pg 1075-1091

2 Brain–gut connections in functional GI disorders: anatomic and physiologic relationships: Jones, MD and colab, Neurogastrointestinal Motil, 2006, 18, 91-103.

3 Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders,  Catassi and colab, Nutrients 2013, 5, 3839-3853.

Integrative Treatment In Psychiatry: A Path To Wellness

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Case Study N.Y.

Main Symptoms

When N.Y. 20, came in for an evaluation with her family, her main complaint was that she could not retain information and was worried about starting school and her performance in college. Her family noticed that she was also very tired, slept a lot and did not seem to follow through on her goals. She complained of very low energy and increased appetite, and was concerned about the weight that she gained and could not lose. She felt sad and worried most of the time- especially about her starting school again and not feeling up for it.

History

N.Y. was never seen by a psychiatrist before and was not aware of any mental illness running in her family. She had been a good student in her country of origin, came to United States when she was in 9th grade and once here, her academic performance gradually deteriorated. She found that she needed more time to accomplish her tasks; she was easily distracted in class, and seemed that she worked twice as hard as her peers to achieve the same results.

Diagnosis

During the first meeting with her-it became clear that based on the clinical history and the self-reported questionnaires that she was suffering from significant depression and anxiety symptoms. At the same time, while her concentration could have been impaired by the presence of an affective disorder, I considered the presence of a comorbid ADHD. At the same time, her lethargy, decreased energy and mental cloudiness could have been explained by an atypical form of depression but I was also concerned about the possible comorbidity with a thyroid deficiency, vitamins deficiencies, or anemia.

I created a customized treatment plan and discussed the plan with N.Y. and her family and decided to start the treatment for the most obvious complaint, the low depressed mood, and test for ADHD when the mood was better through a Continuous Performance test. At the same time, I recommended we run a set of lab tests to address possible biological causes of her symptoms.

The laboratory results confirmed my clinical suspicions by showing signs of microcytic anemia, and significant deficits in Vitamin D, B12, and folate, with an increased homocysteine level that is a marker for a generalized inflammatory state.

The Continuous Performance Test (CPT) test for ADHD showed that she was having a lot of difficulties with maintaining attention, and increased distractibility.

Integrative Psychiatric Treatment For N.Y.

We created a customized Integrative psychiatric treatment program which began to help N.Y. see improvements. N.Y. showed significant improvements on a combination of a medication (an SSRI) for her depressive symptoms and anxiety, Strattera (for ADHD) and targeted supplementation including Vitamin B12, Vitamin D, folate(Vitamin B9), and B-Complex. She was also referred for further testing and follow up with her primary care physician for her microcytic anemia. I also recommended that she start exercising by going for a walk regularly, at least 25 minutes a day at a fast pace. To help her lose the extra weight she wanted to lose we talked about her trying a low-glycemic index diet.

It is possible that with an improved regimen of regular exercise, improved nutrition and supplementation with the appropriate vitamins she might be able to get off the antidepressant in about 6 months. At that time- we plan on repeating the CPT test to assess her ability to concentrate on and off medication, and decide if further treatment is necessary.

Integrative treatment in Psychiatry is becoming more and more popular and effective because it provides a more comprehensive analysis of the potential factors that may influence an individual’s health and mental health. It also provides a more customized plan of treatment that incorporates the interplay of body, mind and spirit and therefore can be much more effective than traditional medicine which takes a narrower view.

If you like this article on integrative treatment in psychiatry, or have questions, schedule your first session by calling us at 713.426.3100.

WHAT IS INTEGRATIVE PSYCHIATRY?

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Integrative Treatment in Psychiatry

Integrative psychiatry integrates traditional modalities of treatment (pharmacological agents, cognitive behavioral therapy, psychodynamic therapy) with complementary and alternative treatment approaches (CAM), attempting to create an individualized treatment approach that takes into account the individualized needs of the patient.

The classic treatment of depression, for example, would include pharmacotherapy and talk therapy. However, there are more facets that relate to its successful treatment, and resources that would be helpful to all patients struggling with depression, especially to those who encounter their own resistance to try medications or therapy.

Examples of Complementary Modalities of Treatment

For the minor to moderate depressive disorders, exercise has been proven to be an effective treatment if it’s done ‘effectively.’ Combining that, with a good nutrition and adequate supplements, will help the brain to restore adequate production and preservation of neurotransmitters (serotonine, dopamine, and norepinephrine) that are involved in mood modulation. The patient frequently hears their doctor’s advice on starting exercising, but frankly this task sometimes seems insurmountable to depressed patients who struggle with decreased energy, initiative and interest. It has also been shown that a person who has never had a rigorous or disciplined exercise schedule has a difficult time starting one. Therefore, it makes sense to receive that more detailed guidance at the same time as a prescription for medication or traditional therapy.

Most people also are told by their medical practitioner to maintain a “healthy diet.” However, unless the psychiatrist takes interest in understanding the patient’s eating habits and how they are affected by depression and goes through the education of how a poor diet delays the recovery from depression, most patients would not know where to start to make changes.

A Comprehensive Approach to Assessment

For the treatment of depression, besides just evaluating the way that the patient forms and maintains relationships and address that in traditional therapy, it would be equally as important to engage the spiritual resources, if any, that the patient has at his/her disposal. Sometimes participating in the religious rituals of the community can help speed recovery by providing a direction to the healing. We also explore resources like meditation and yoga to new a few.

Vitamin/Supplement Research and Depression

More studies show that there is a relationship between vitamin deficiencies and anxiety or depressive symptoms. For example, Vitamin D deficiency, along with B complex deficits are known causes for some of the symptoms we target with antidepressants. A significant number of depressed patients are testing positive for genetic mutations that prevent appropriate incorporation of folic acid in the metabolic process of manufacturing neurotransmitters. Therefore, it is important to identify this mutation, and if found, provide supplements with methylfolate that could be an easy treatment for refractory depression.

Other Non-Invasive Treatment for Depression

Along the same lines, light therapy and transcranial magnetical stimulation (TMS) are noninvasive methods of treatment for people who suffer from depression that traditional medications do not help, or create side effects. These non-invasive therapies would also make more sense for pregnant women, who are reluctant, for obvious reasons, to start antidepressants- especially in their first trimester of pregnancy.

Integrative Treatment Case Example

In summarizing with an example, the treatment for a moderate single episode of depression could change from an SSRI prescription and referral to weekly therapy, to a more individualized treatment plan that would include: Omega 3 supplements (fatty acids), tryptophan and 5 HTPT supplements, Vitamin B complex with or without vitamin D and/or B12 replacement therapy, a scheduled aerobic exercise 20-30 minutes a day for 5 days a week, dietary changes towards a more balanced approach of ingredients, light therapy ( for seasonal depression) or TMS therapy for patients who could not tolerate the medication’s side effects. Supplementing with SAMe, Methylfolate and NAC would also help to boost the initial response to the treatment as well.

If you like this article on what is integrative psychiatry, or have questions, schedule your first session by calling us at 713.426.3100.

Daniela M. White MD Psychiatrist

Daniela M. White – MD

Dr. Daniela White received her training in general psychiatry at Baylor College of Medicine, followed by a fellowship in Child and Adolescent Psychiatry.

Her private practice, started in 2002, is currently outpatient-based, and provides the appropriate care based on modern psycho pharmacology in a relaxed and welcoming environment.

Her integrative psychiatry model is a very holistic model of treatment that looks at health and mental health markers to thoroughly assess what is going on.

Dr. White and her staff strive to make patients feel comfortable from the moment they step into the office and try to initiate care as quickly as possible. Phone calls are returned promptly and the coordination of care is maintained with the other care providers involved in the patient’s treatment.

If you like to make an appointment with Dr White, schedule your first session by calling us at 713.426.3100.