Heal Your Gut, Heal Your Mind - Naturopathic Perspectives

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The Gut/Brain Connection

Irritable bowel disease (IBD) includes ulcerative colitis (UC) and Crohn’s disease (CD). It is one of the five most prevalent gastrointestinal diseases in the United States. People with IBD and other gastrointestinal diseases like irritable bowel syndrome (IBS) suffer from the effects of damaged gut tissue due to inflammation. The symptoms are often life-altering, painful, and chronic.[1]

The gut and the brain are highly integrated. They communicate bidirectionally through the autonomic nervous system (ANS) and the endocrine hypothalamus/pituitary/adrenal (HPA) axis using serotonin, tryptophan, cortisol, epinephrine, and norepinephrine.[2] Feedback from the gut goes to the emotional motor system (EMS) in the brain, also known as the limbic system. Since there is bidirectional communication, it is important to understand the role of the limbic system to understand how the two interact. The limbic system is responsible for both the internal and external homeostasis of the organism. When there is an internal or external event causing imbalance, the limbic system senses this and releases hormones into the body to rebalance. The limbic system facilitates survival, threat avoidance, social interaction, and learning. Emotions are generated here, and the associated physiological changes are the work of the limbic system. The limbic system is involved in the “top–down” modulation of visceral pain transmission as well as visceral perception. The limbic system is the traffic-control centre where the brain and gut interface and interact.

What Happens in Gut Disease?

There are four hypotheses to explain the causes of IBD: genetic predisposition, environmental triggers, immune system hyperactivity, and chronic inflammation. The concordance rate in identical twins is 10–15% for UC and 30–35% in CD, demonstrating that nongenetic factors may have a large role in disease development.[3] Different environmental factors have been identified:

1. Psychosocial stressors activate stress circuits within the EMS, leading to physiological gut responses via the autonomic and endocrine systems. EMS output causes corticotropin-releasing factor (CRF), cortisol, norepinepherine, and epinephrine to be released. These molecules shift the immune system towards a Th2 response: Increased mast cells as well as nitric oxide synthase expression.
2. Autonomic responses can directly or indirectly modulate the gut’s permeability to antigens (foreign particles) and microbes (bacteria). When the gut’s permeability increases in response to antigens and bacteria, the immune system activates to protect our bodies from the foreign invaders. A highly permeable gut can lead to gut hyperpermeability disorder a.k.a. leaky gut.
3. Physical stressors such as antigen and bacteria modulate gut immune function, and immune products from the gut such as cytokines and chemokines create inflammation and pain seen in IBD.

UC is characterized by inflammation limited to the colon region of the intestine. CD can involve any part of the digestive tract but is most commonly found in the terminal ileum or perianal region. CD is associated with complications such as strictures, abscesses, and fistulas.[4]

The Intestinal Mucosa Is Important

The intestinal mucosa is very important to gut health. Its functions are nutrient absorption, physical barrier, and signal transduction. It senses its environment and secretes regulatory products in response. The digestive tract also contains the largest component of the immune system in the human body.[2] People with IBD have a disrupted intestinal mucosa. Without a healthy mucosa, bacteria seep into the bloodstream, initiating an immune response that leads to chronic, damaging inflammation and pain.
An astounding fact is that 95% of our serotonin is made in the gut. Serotonin is responsible for our subjective feeling of happiness and good mood. If our gut tissue is not healthy, we can not make adequate serotonin.[5]

Painful Inflamed Gut Alters the Brain: Depression and IBD

As mentioned earlier, gut control is chiefly within the limbic system in the brain. It is also where emotions, physical and sexual drive, sleep, appetite, memory processing, stress response, and mood disorders are controlled. When there is a homeostatic imbalance like pain or inflammation due to IBD, the limbic system responds to rebalance the system. The activities in the limbic system are so important and ubiquitous to the functioning of a human being that disturbances in any part can alter and affect mood and behaviour. One of the changes seen in the brain of patients with acute colitis is the upregulation of neuropeptide Y (NPY).[6] For the most part, NPY seems to be a protective and helpful response to pain. One study shows that NPY is part of the mechanism that helps mammals recover from intense pain associated with inflammation or nerve injury.[7] NPY is also responsible for reducing anxiety and stress, modulating sleep/wake cycles, reducing voluntary alcohol intake, lowering blood pressure, and controlling epileptic seizures.[8][9] The role of NPY in increasing food intake and storage of energy as fat can become detrimental if it is chronically stimulated. In addition to pain and inflammation, stress, as well as high-fat and high-sugar diet have also been shown to increase NPY levels in the brain.[10] NPY upregulation is a function of IBD and one of the links between IBD and depression.

Today, there is strong evidence to support the connection between IBD and depression. Depression has been shown to occur one year or less before a diagnosis with UC, meaning that symptoms of undiagnosed UC cause depression—or, conversely, that the occurrence of depression may be a cause of UC.[11] In any case, they are concurrent. Anxiety and depression are more common in patients with IBD, and their symptoms are more severe during periods when the disease is active. Additionally, the course of the disease is worse in depressed patients. Treatment with corticosteroids, a common treatment of choice for patients with IBD, can induce mood disorders or other psychiatric symptoms.[12] The link between the gut and mental health is clear. There has never been more reason to treat and heal the gut for patients with gut inflammation or mental disorders. So, lets get started.

Healing the Gut to Improve Depression

1. Remove Stressors
   Physical stress—like a nutrient poor diet, processed foods, history of antibiotic use, or too much sugar—damages the gut and weakens our immune system. Not getting enough sleep is a physical stress. Emotional stress can include our job, money, primary relationships, and more. Identifying what causes you stress is a good first step on the road to wellness. Working on how to decrease stressors is an ongoing process. Utilize family and close friends to identify and mitigate stressors in your life.
2. Clean Up the Diet
   Oxidative stress from proinflammatory foods appears to play an important role in the neurodegeneration of the ENS and enteric glia.[13] Many foods cause inflammation, by being allergenic, toxic, or both. The removal of proinflammatory foods that we don’t need and are expensive and detrimental to the gut is the second most important step to healing the gut.
   • Removing Processed Foods: Anything that comes in a box or can is processed. Processed foods are lower in nutrition than fresh, whole foods, and are made with a variety of ingredients that do not support good health, like GMOs, high-fructose corn syrup, and preservatives, to name a few. Many whole foods options exist in the grocery store that are just as easy to consume and cheaper than buying processed, premade food. Consider eliminating packaged frozen meals, packaged cookies, granola bars, frozen pizzas, French fries, hot dogs, deli meats, potato chips, candy bars, soda, salad dressings, ice cream, instant noodles, and Kraft Dinner®. Whole foods are the fruits, vegetables, nuts, grains, and seeds we see in their natural forms. They are often located on the perimeter of a grocery store. Substituting whole foods for processed foods will make a big difference in your health. Just ask Dr. Terry Wahls, MD; she healed herself from MS using whole foods, and you can see her TEDTalk at https://www.youtube.com/watch?v=KLjgBLwH3Wc
   • Eliminating Pesticides: Remove pesticides from your diet by buying exclusively organic or washing your fruits and vegetables in a water/vinegar mixture of 10:1. Some of the more fatty foods like nuts need to be bought organic because they absorb pesticides more readily than fruit or veggies with a water-resistant peel.
   • Add in Foods That Are Gut-Healing:Flax seeds and chia have a mucilaginous, gooey coating that is healing for gut tissue and contain fibre, protein, and omega‑3 fatty acids which help to bulk-up stool for elimination and decrease inflammation respectively. Flax seeds can be made into delicious crackers, taken as oil, or ground up and put into oatmeal. When soaked, chia becomes chewy and can make an excellent pudding. Cabbage contains the amino acid glutamine, which helps to heal the enterocytes (cells of the GI tract). Raw cabbage can be grated into salads or eaten as a slaw.
   • Nut soaking helps to neutralize the phytic acid found in the outer later of nuts. Soaking nuts and seeds for six hours before eating makes it easier on the intestines to digest and absorb their nutrients.
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   • Rinsing your grains before you eat them helps to remove the saponins found on their outer surface. Saponins bind to the mucosal epithelium and increase surface permeability. Too many saponins and other gut toxins can lead to leaky gut.
3. Heal The Gut: Supplementation
   • Glutamine: An amino acid that acts as food for enterocytes in the gut, helping them repair and close their tight junctions.
   • Lactobacillus helveticus and Bifidobacteria longum: These have been shown to help IBD, while B. infantis relieves many of the symptoms of IBS.[14]
   • Fish Oil: Helps to decrease inflammation and support cognitive functioning of the brain.
   • Herbs: Ulmus rubra (slippery elm), Glycyrrhiza glabra (licorice), Althaea officinalis (marshmallow), and Avena sativa (oats).
4. Support Adrenal Glands
   Since cortisol is expended during the homeostatic process, long-term stress can lead to cortisol resistance and adrenal fatigue. You can support the adrenal glands using vitamins like B5 and C, herbs, and homeopathy.
5. Social Support
   Reaching out to people in your community, family, and friends is an important part of maintaining good mental health. Social support lowers stress, anxiety, and depression and improves outcome for patients with IBD.[15]