Food as Therapy: The Gut’s Role in Mental Health
The age of the mental health epidemic?
As we settle into the 21st century we see how movements of social change are firmly established in global society. Positive shifts are in motion as we seek to cultivate a world where fairness prevails, and people of all walks of life are free to live happy and healthy lives.
With this in mind, when we consider the prevalence of mental health issues, it’s disappointing. Mental, neurological and substance-use disorders are now attributed as the largest burden of disease across the globe, surpassing the impact of cardiovascular disease and cancer. Over 300 million people currently battle depression (an increase of 18% from 2005 to 2015), and worryingly, the latest figures from the WHO reveal that 800,000 people complete suicide each year, equating to losing one person every 40 seconds. In some countries this figure is rising, Time reports that the US is now experiencing its highest suicide rate since World War 2. The good news is that global rates are falling thanks to a multitude of efforts from healthcare agencies and other organisations, showing us that deaths from suicide are preventable, a promising example of how human intervention can change someone’s life for the better.
The fact that mental health is being viewed as a “global epidemic” is a call to action, and not just for healthcare professionals and government agencies. It’s time to think outside the box, and combine our knowledge across disciplines, become creative problem solvers and even look back to some forgotten, but very valuable knowledge.
Time for change
We are at an exciting point of change when it comes to understanding and treating mental health. It was in the 1950’s when we last drastically advanced our knowledge and abilities in this area with the birth of psychopharmacology. The synthesis chlorpromazine paved the way to understanding psychology as being rooted in biology. Aetiologies were uncovered in a biological, brain-based sense, and drugs were developed with a view to “reset” abnormalities. While the leap in learning allowed us to understand in fine grain detail the mechanisms of the brain, and carried implications in psychological treatment, the use of drugs has found its limits. A recent paper published in the Australian & New Zealand Journal of Psychiatry revealed that there are few new psychiatric drugs under development. This coupled with the fact that mental health remains a marked problem in our global society, signals that a drastic change is needed is we want to continue to improve treatment options. We could theorise that developing new and more innovative drugs could provide a resolution, but an increasing number of studies are showing that medication is not as effective as we would want it to be, and it may even be doing more harm than good in the long term. So it’s time to turn to something new. It’s time for the paradigm shift. And the world’s creative thinkers have it.
The brain doesn’t equal the mind
A growing body of evidence is elucidating a connection between mind and body that modern science hasn’t accounted for. Modern medicine has associated mental health with the head. It makes sense, our brain is responsible for our thoughts, our emotions, our memories, and there is a wealth of research explaining how our brain works in relation to our psychology. But, a new wave of scientists who are showing us that this isn’t the entire picture.
Trust to your gut. A gut reaction. Gut instinct. Gut feeling… Ever pondered these phrases that are so common to the english language?
Research has found that our gastrointestinal tracts are in fact lined with neurons, suggesting an incredible line of communication between gut and brain. Scientists around the world are conducting studies into its significance, it’s opened up an important avenue of exploration, and it’s suggesting that mental health is not limited to the head. While different parts of our body are engineered for specific tasks, they do not work independently of one another, we are an assimilation of parts working in harmony. Mental health is about the whole body, and like the brain, the gut may have an important role in modulating this.
A Finnish team of biomedical engineers paint a perfect example of how mental health is not limited to the head. They found that our emotions are felt all around the body, and that cross-culturally we feel them in the same way. Emotions like anger, fear and anxiety are associated with increased activity of the chest and upper body, which makes sense when we think about how our hearts race when we’re frightened. Love on the other hand illicit decreased activity in the legs… “legs go to jelly” now seems like a very apt description of how we feel when we’re falling for someone. Relationships with the physical and psychological are there, they’ve just been overlooked in terms of how we can utilise them to help people who are suffering. But now, that’s all changing, and the digestive system is becoming understood as a key player in mental health.
Nutritional Psychiatry: An opportunity for a paradigm shift
Data coming out of labs around the world looking into this relationship is astounding. Experts are showing us that the behaviour of our digestive system can impact how we feel, and can even be linked with diagnosable disorders. So far we know that vascular function, inflammation, metabolism, central activation, improved neural efficiency and angiogenesis as well as microbiome imbalance (gut dysbiosis), oxidative stress, and impaired mitochondrial output all impact our psychology. This area of study is gaining momentum and the outcome is that we are realising that what we introduce into our gastrointestinal system can influence how we feel. The onset of this research has constructed a new academic focus, and it is being referred to as nutritional psychiatry/psychology.
So what do we already know? The data that has been collected over a short period is undeniably impressive in determining that our food is a very powerful tool that few of us are utilising properly. Let’s jump back to the fact that scientists have found neurons in our gastrointestinal tracts. In addition to this, it has also been uncovered that around 95% of our serotonin (responsible for everything from mood regulation, social behaviour, appetite and digestion, to sleep, memory, and sexual desire) is produced in the gut and not in the brain, as we would have assumed. This alone doesn’t explain how the gut brain interaction works, but it clearly demonstrates that there is an information highway between the two, and that this highway likely modulates psychological factors.
How can we take advantage the discovery of this mechanism? And what is its significance for therapeutic treatments. The key lies in the fact that modulating the microbiome of the gut, by changing what we eat, can influence a number of mental health problems.
Change your microbiome, change your state of mind
The evidence to support this is accumulating fast. For example, recent research has shown that people taking probiotics to add to the good bacteria in their gut had lower anxiety levels, lower perception of stress and an improvement in mental outlook in comparison to those who didn’t. Further to this, studies have shown that poor diets are a risk factor for depression, and it strongly correlates with the mood disorder. In 2017, a study measured level of depression and remission in people with moderate-to-severe depression who underwent a 3-month dietary intervention. The data was clear, those suffering from depression who modified their diet showed greater improvement, and also were more likely to go into remission than those in the control group.
With much promising evidence being discovered, this offers a new opportunity for developing treatment options. It means that in the not so far future we could potentially see the prescription of diet plans rather than medication, education on diet may be added to the curriculum enabling the next generation to have a deeper understanding of mental illness and it’s preventions.
To some, the idea of what we eat impacting our mood may seem obvious but view it to have limited applications. Many of us realise that if we eat junk food we are going to feel sluggish, and that if we choose the healthy option we’re likely to have more energy and mentally feel better for having made the healthy choice. However, dietary amends go further than simply eating healthy. Researchers have found that specific foods have different impacts on our mental wellbeing, and the reason for this due in a large part to the changes to the microbiome of the gut and impact on inflammation of the body (inflammation of the GI tract and brain have been linked with both poor diets and mental health problems).
The microbiome of the gastrointestinal tract describes the dynamic population of microorganisms that we harbour. For each person this will be different, and this is because the micro-organisms present in the GI tract are mostly due to the food we eat. Pre and probiotic foods can have a positive impact on certain mental health conditions. Further to this, numerous studies undertaken in recent years have uncovered specific diets, foods, and nutrients key for improving mental health.
Eating your feelings?
Harvard Health recently informed us that the Mediterranean diet can protect against depression because of its anti-inflammatory impact, and a 2012 study has been able to attribute diets low in fruit and vegetables but high in processed foods to higher levels of both depression and anxiety, a finding that has been replicated over and over.
Research is now at the point where we are able identify the specific foods and even vitamins and minerals that are helpful. In 2018, a Canadian team successfully identified folate, iron, long chain omega-3 fatty acids (EPA, DHA), magnesium, potassium, selenium, thiamine, vitamin A, vitamin B6, vitamin B12, vitamin C, and zinc as the 12 antidepressant nutrients. The team also discovered that watercress, spinach, mustard/turnip/beet greens, lettuces (red, green, romaine), swiss chard, fresh herbs (cilantro, basil, or parsley), chicory greens, pummelo, peppers (bell, serrano, or jalapeno), and kale or collards are the top 10 foods in terms of containing the highest levels of the 12 nutrients. In terms of reducing anxiety, interventions with Atlantic Salmon have been shown to decrease symptoms in inpatients.
Food’s healing effects aren’t limited to anxiety and depression. Recent studies have shown diet interventions reducing symptoms for those with ADHD, autism spectrum disorders and even potentially for schizophrenia.
So how is food helping? We know that it changes the gut’s microbiome, and can reduce the inflammation linked with many disorders. But why do different foods work with different disorders?The fact is that neurotransmitters play an important role in the development of mental health disorders, and each disorder is related to a different interplay of these. To synthesise these neurotransmitters, many metabolic steps must be taken, and it is vitamins and minerals that are required as cofactors to the numerous enzymes required for almost all of these steps.
Food as therapy?
Theoretically a future treatment option, or supplementary treatment of mental health problems could be adjusting our diets to include the profile of vitamins and minerals needed to influence the neurotransmitters involved in the problem we wanted to target. The human brain is incredibly complex, and so are mental health problems. We know that there is no single factor responsible for the development of a mental health problem. However, with this growing body or research we are growing options to treat them. And given the diversity of humankind, for those who may be less suitable or responsive to current treatments, this may provide them with an avenue to remission.
Understanding the interaction between diet and psychology lends itself equally to prevention through education, giving people the tools they need to lead a happier and healthier life. Further future prospects out of this body of research have many implications to the changes we can make in our own lives. A little knowledge can go a long way. Knowing what foods will have a positive impact on our lives, and those that have a negative impact, give us the possibility to maximise and minimise the right foods to give us the best chance of preventing, and recovering from mental anguish.
