The Gut-Brain Connection
What do you know about the gut-brain connection? The theme for mental health awareness week (21-27th September 2020) was “Reimagining Wellbeing Together.” This topic is pertinent for 2020, as with the endurance stage of the pandemic we all face chronic stressors - and must innovate if we are to help each other through this changing time.
In the 17th century, the philosopher Descartes suggested that the mind was separate from the body, known today as mind-body dualism – the mind was delegated to “talk therapists” while medical doctors were left with the brain and physical body. Today, our evolving understanding of the gut-brain connection has re-connected the mind with the physical, requiring that we use integrative therapies.
Using a biopsychosocial/spiritual model (Sir Mason Durie’s model - Te Whare Tapa Whā) we consider a holistic view of health – including the mind (Taha Hinengaro) and the body (Taha Tinana), among other domains required for balance (Wairua/spiritual, Whanau/family). When one domain is out of balance this places strain on others – if the body suffers the mind may express this, and vice versa.
According to the World Health Organization Global Burden of Disease study (James et al., 2018) we have become chronically sick, unlike earlier times in history when we faced more acute health problems or accidents. We are now living longer but these extra years are spent chronically unwell – with persistent ill health concerns such as type 2 diabetes, heart disease, autoimmunity, dementia and mental health concerns like anxiety and mood disorders. In the WHO study, non-communicable diseases were found to account for 82% of disability in New Zealand in 2017. Research also finds extremely high co-morbidity between mental health and physical health concerns, for a multitude of reasons (Firth et al. 2019).
One reason for this chronic health phenomenon is our evolutionary mismatch - we live a modern lifestyle that is incompatible with our human physical, emotional, and relational wiring. Our collective gut-brains are suffering as a result.
What exactly is the gut-brain?
Imagine a 2-way super highway from the brain-down & the gastrointestinal tract (GIT)-up. Most of the traffic goes from the gut to the brain, however, the impact of the brain on the gut can be profound via our mind and our stress response. For simplicity (it’s not!), we can consider 5 interacting parts:
1. The nervous system – especially the autonomic nervous system (fight-or-flight vs. rest-&-repair) via neurotransmitters and the vagus nerve.
2. The endocrine system – which helps maintain immune & metabolic balance - uses hormones via our blood system (e.g., stress/thyroid/reproductive hormones).
3. The immune system – uses cytokines via the blood system & is affected by periods of chronic stress & inflammatory triggers.
4. The gastrointestinal tract & gut microbiome mediates the gut-brain through bacteria, which can influence thoughts, emotions & behaviour.
5. The mind – the way we think, our feelings, our personality, our attachment style, & the experiences in life that have shaped us. These all impact what happens at a gut level.
When the gut-brain suffers there are many possible physical & psych indicators that can get louder over time:
Physical:
• Intestinal & brain permeability or “leakiness”
• IBS
• Food intolerances/sensitivities/cravings
• Appetite changes
• Hormonal problems
• Blood sugar mayhem
• Nutrient depletion
• Sleep difficulties/unrefreshing sleep
• Exercise intolerance
• Weight changes
• Recurrent sickness (e.g colds)
Psychological:
• Brain “fog”
• Anxiety/panic attacks
•Depression/irritability/overwhelm
• PTSD
• Fatigue
• Low motivation or zest
• Impaired focus/concentration
• Reduced stress tolerance
• Turning to old coping/addiction
• Social/relational impacts
• Difficulty meeting usual life demands.
A vicious cycle often develops – the worse we feel the harder it is to do things that help, the harder it is to cope with usual stressors, & one small thing can break the camel’s back. The good news is, there are so many effective inroads to interrupt the vicious cycle and improve gut-brain functioning.
The gut-brain & the endurance stage of stress
We live in a modern world designed to keep our nervous system switched to threat. This means we often enter an endurance phase in order to keep up. The global pandemic is an example of an endurance stage as we have many ongoing stressors requiring our nervous system to help us through. Exhaustion or burn-out can be the end point of endurance where the body enforces rest through disabling our usual capacity to push on. This looks much like depression, and requires removal of the chronic stressors paired with rest and recovery in order to re-balance.
To care for your gut-brain it’s important to interrupt the endurance cycle to get the balance back, in order to help your body out of survival mode at least some of the time. Right now, during this pandemic we can constantly feel not safe or on edge, as we work towards adjustment and change. The body holds so much of this stress for many people.
Luckily, there are so many inroads to helping your body out of survival mode - I always encourage people to start where they feel most drawn. The overall aim is to calm the mind and body and to focus on right now - rather than the multitude of past woes or future worries ahead.
The brain is the driver of the stress response. This can be conscious (e.g., the way we think about things) or automatic (via your sense detector and memory). We can intervene at either a top-down or bottom-up level - here are a few examples:
Top-down interventions – help turn off the stress alert
* Examine your values
* Mindfulness skills
* Emotion regulation skills
* Specific therapy modalities
* Device-free time – turn off notifications
* Focus on the essential
* Attachment-based work
* Address hyper-vigilance/PTSD
GIT-up interventions – support rest & recovery mode
* Sensory grounding techniques
* Yin movement instead of high-intensity
* Deep belly breathing
* Restorative sleep (usually 8+ hours needed)
* Walk in nature
* Take a caffeine holiday
* Structure meals around protein and healthy fats at meals - especially in the morning
* Increase seasonal and local fruits/vegetables
* Supplements to support stress (e.g., B vitamins, magnesium, zinc)
* Take an alcohol holiday
* Relaxing teas (e.g., chamomile, valerian, passionflower)
* Adaptogenic/nervine herbs (consult with a herbalist)
The gut-brain & inflammation
With a focus on the physical domain of holistic health - taha tinana - we have the perfect chance to talk about the process of bodily inflammation and how this can cause or contribute to mental health concerns for some people, in particular if you have experiences that are more chronic in nature and co-occur with other inflammatory symptoms (e.g., achy joints, chronic pain, period problems, “brain fog”).
My passion as a clinical psychologist is to integrate the realms of mind and body with nutrition and lifestyle, so that these are not treated as separate entities. I am not an immunologist, however I have spent my years as an integrative practitioner learning as much as I can about a particular theory known as the cytokine theory in relation to mental health. This comes from a branch of science that I first heard about as a student, and it intrigued me even then – psychoneuroimmunology. More recently it’s been extended to psychoneuroimmunoendocinology (can anyone even pronounce that?!) - because of the interacting roles of the mind, nervous system (via the vagus nerve), immune system AND endocrine (hormonal) system in chronic mental health presentations.
Let me do my best to sum up cytokine theory:
In 1990, pioneer immunologists proposed that inflammatory proteins (cytokines) in the blood could get across the blood brain barrier (BBB) and have detrimental effects on the mind.
The BBB is a protective mechanism to keep most pathogens out of the brain however, much like the process of intestinal permeability (“leaky gut”) it is now known that the BBB tight junctions can be opened by inflammatory factors in the blood (cytokines).
There is also a strong relationship between intestinal permeability (GIT) and brain permeability – in other words, if you have leaky gut you have leaky brain. And these days we mostly all have some degree of leakiness going on.
So what does this process mean for mental health? One symptom of inflammation is a phenomenon referred to as “sickness behaviour.” This term refers to the following symptoms which are designed to respond to inflammation and support recovery:
* Fatigue
* Melancholy
* Social withdrawal
* Physically slower
* Sleep and eating is disturbed
* “brain fog”
Sound familiar? This maps onto some of the diagnostic criteria for depression.
One factor in rates of chronic depression today is our evolutionary mismatch, thus chronic inflammation may be contributing to depression for some individuals. Rather than acute inflammatory triggers we instead live a chronic inflammatory lifestyle (diet, stress, movement level, sunlight deficient, toxic exposures, medications) incompatible with our human wiring – these daily triggers in our modern life means that sickness behaviour can become long-lasting.
Why was sickness behaviour potentially adaptive to humans?
Darwin’s natural selection principle:
* Depressive response to infection/inflammatory challenge was advantageous to our survival.
* Genes that make us more likely to survive – help to kill off infectious germs, to dictate that energy is conserved, and ensure infection not spread to others, thus being less of a “burden” on the tribe.
Inflammation is impacted on via the gut-brain axis – and in particular the foods we do or don’t put into our gut in the first place.
This is one of the reasons that the Mediterranean diet has perhaps been found to be effective as an intervention for major depression (e.g., the SMILES and HELFIMED trials - Jacka et al. (2017) & Parletta et al. 2019, respectively). This removes many modern inflammatory triggers (e.g., unhealthy fats, processed foods) and increases anti-inflammatory foods (fruit and vegetables, omega 3 fats), although may not be sufficient for all - as some potentially inflammatory triggers are included (e.g., gluten and dairy).
If you think your mental health may be affected by chronic inflammation I recommend working with someone to find your unique triggers, to help heal permeability of the gut and brain, and to maintain an anti-inflammatory diet and lifestyle including adequate sleep and rest plus regular movement.
Your mind & the gut-brain.
Your mind - taha hinengaro - is incredible with how it constantly provides thoughts & feelings to try & help you keep safe & live a connected & meaningful life. We each interpret things through our own experiences, our personality & our history. We have both a conscious filter & an automatic response (in the part of our brain designed to respond to threat and remember past dangers or hurts).
Your conscious mind can become a chronic driver of gut-brain stress (via the HPA-axis) in our “busy” modern world - when you spend time struggling in past rumination or future worries.
Focusing on this conscious aspect of your mind, this is where mindfulness skills are helpful. In my practice I teach ACT (Acceptance & Commitment therapy) to get into the present moment & out of ‘monkey mind’.
A couple of ACT tips & tricks for when you’re going around & around in thoughts & feelings
Get PRESENT – ground yourself to your sensory experience & “be here now.” Feel your feet on the floor as an anchor, notice what you can feel (temperature, texture), hear (sound, rhythm), or see (taste or smell can be used too). Notice what it feels like to focus on these things and to come back to them when your mind wonders.
UNHOOK from thoughts – your minds job is to give you thoughts & ideas – & it’s generally trying to help you, however we tend to assume that what is says is the truth, should be bought into, and needs to be acted upon. Instead can you notice that part of your mind that is providing these thoughts and ideas (sometimes images not words)– as though you are in an audience watching a show play out on the stage - say to yourself “I notice I am having the thought that___________“ - insert your difficult thought here (e.g, no one cares about me, I’m not smart enough, I don’t fit in). Then return your attention to what you are doing in the present moment or your next breath. Notice how you can create a sense of distance from the thought instead of being merged with it. Note. this skill can takes some practice to build the muscle!
Can you LABEL the thoughts that you observe in your mind – “here is worry” or “this is the ‘not good enough’ story.”
ALLOW feelings – when it comes to emotions there is a strange paradox - “if you don’t want it you’ve got it.” We often try to avoid, numb or push away difficult feelings. This can make them sticky and repetitive. By instead simply allowing them to come and go they often can simply just do their job (to give you information about what matters to you or to help you take action according to your values) & then can eventually pass.
4 Steps (adopted from ACT trainer Dr. Russ Harris’s expansion exercise)
• Identify WHAT you are feeling – sadness, anger, shame, or even noticing that “here are emotions.”
• Notice WHERE the sensations are located in your body (stomach, chest, throat?).
• BREATH into these feelings.
• Make SPACE for the discomfort – even though it’s unpleasant.
• ALLOW the experience to just be there - say to yourself - “even though it’s uncomfortable I am willing to allow this feeling.”
Gut-brain connection summary
The gut-brain axis is an incredible bi-directional communication network linking your gut microbiome, your stress response and other hormones and immune system, your personality and all your relational and life experiences to date. By integrating a top-down and gut-up approach you can best support yourself and those you love through the endurance phases of life. While we can’t always change the stressors we contend with we can together learn how to each improve our ability to rise to the challenges we face. The overall aim is to help the mind and body to calm down and to come back to the present moment - the more you can build up this muscle and keep it toned the more you can respond to life stressors with less physical reactivity and a greater ability to use your mind and body to help you survive and take action.