As surprising a connection as it may sound, it is quite often the case that it is the gut which causes different manifestations of depression in a person. Diseases as common as Irritable Bowel System (IBS) and other gut related ailments are less commonly known as causes of depression. While most people do have a general understanding of the gut, many are not aware of the significant impact it has on other aspects of a person’s health. The Gastrointestinal tract (GI Tract), digestive system, or ‘gut,’ is a group of organs that includes the mouth, esophagus, stomach, pancreas, liver, gallbladder, small intestine, colon, and rectum. The gut serves many essential roles in sustaining and protecting the overall health and wellness of our bodies, starting with the intake and absorption of nutrients and water. The central role that the gut plays in the human body means that it has the potential to cause significant damage to other important areas such as the brain, immunity, and nutrition if it is not properly cared for.
A simplistic definition of the gut would be that it is a long tube contained within the body. While it may not be immediately apparent, the gut is exposed to the external environment via the mouth, with the rest remaining coiled inside the body. As food and other substances enter the GI tract through the mouth, they pass through the multiple regions of the gut to be digested, absorbed, or removed. When our digestion is compromised, our bodies can under-produce neurotransmitters, like serotonin (95 percent of serotonin is produced in the small intestine). Serotonin is a hormone that helps regulate our mood, emotions, and energy levels. Low serotonin levels are often linked with anxiety, depression, and other mental health issues. First, the gut provides information to the brain, while the brain helps us decide what, when, how much, and how fast to eat and drink. The gut and brain work together in the digestive process. Even though it is not always the case with issues as complex as mental health, cleaning up your diet may often help relieve symptoms such as brain fog and sadness.
In a recent article for the New York Times, science journalist Sandra Blakeslee argues this case, writing that “As we might imagine, stress can result in adverse effects on the gastrointestinal tract and the whole body. Stress can cause chronic nausea or bloating, and can be a trigger for disease flares or exacerbation of symptoms in people who have diseases like Irritable Bowel Syndrome (IBS), which is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. Gut feelings get all the press, but your gut may be more of a thinker than you know. Some scientists now consider it a second brain. While it won’t necessarily help you study for an exam or get a promotion, your gut can influence the chemistry of your mood, emotions, immune system, and long-term health. Research even suggests the gut can “learn” new tricks through conditioning. Each of us literally has two brains — the familiar one encased in our skulls and a lesser-known but vitally important one found in the human gut. Like Siamese twins, the two brains are interconnected; when one gets upset, the other does, too.”
In addition, both the brain and gut play key roles in our stress level, and our mood or state of mind. The gut may inform the brain of a stressor, and the brain will do the same for the gut. Not only this, but the gut is filled with nerve cells that receive and provide information to the brain. Since your gut is supposed to be your ‘second brain’, it transmits information to your brain via the Enteric Nervous System. (Nervous system of gastro intestinal tract). There is a close connection between abnormal gut flora and abnormal brain activity. Just like the neurons in the brain, there are neurons in the gut. These are what produce neurotransmitters like Seratonin. Thus in many case, it is an unhealthy diet that causes depression. Your gut bacteria are heavily dependent on your diet and also vulnerable to your lifestyle. Therefore, gut health impacts your brain function, psychological health and behaviour. They are simultaneously interdependent and interconnected.
Some gut bacteria help keep the gut healthy which is a major factor in mental and physical well-being. Many types of bacteria are classified as probiotics. They all have different benefits, but most come from two groups. Lactobacillus, which is the most common probiotic found in yogurt and other fermented foods. The second type is Bifidobacterium, found in other dairy products. These probiotics may often help ease the symptoms of Irritable Bowel Syndrome (IBS), and in turn help improve mental health.
Among other things, probiotics help send food through your gut by affecting nerves that control gut movement. While prebiotics and probiotics sound similar, these supplements are very different and have different roles in the digestive system (or gut). Prebiotic fiber is a non-digestible part of food like bananas, onions and garlic, the skin of apples, beans, and many others. Prebiotic fiber goes through the small intestine undigested and is fermented when it reaches the large colon. This fermentation process feeds beneficial bacteria colonies (including probiotic bacteria) and helps to increase the number of desirable bacteria in our digestive systems that are associated with better health and reduced disease risk.
‘A helpful metaphor to understand the difference between a prebiotic and a probiotic may be a garden. You can add seeds—the probiotic bacteria—while the prebiotic fiber is the water and fertilizer that helps the seeds to grow and flourish.’
The gut is a highly integrated system that can impact nearly every system in the body. Being well-educated on the gut’s influence is an important part of maintaining overall wellbeing. By taking the appropriate steps to support gut health, you can improve numerous bodily functions such as mood, immunity, and brain function. Behind the curtain, our gut is responsible for putting our body into working order. As it breaks down the foods we eat, our gut absorbs nutrients that support our body’s functions — from energy production to hormone balance, skin health to mental health, and even toxin and waste elimination. In fact, about 70 percent of the immune system is housed in the gut, so making sure our digestive system is in tip-top shape can be key to addressing many of our bodily woes. But how do we translate our gut feelings into health solutions? Your gut may not be a literal voice, but its functions communicate in a form of code. From complete silence to hunger grumbles and bathroom habits, these things can give you insights into what is going on inside.
One of the premiere methods of supporting greater gut health is through diet. Optimizing diet by removing harmful substances and incorporating more beneficial foods can allow for gut restoration and greater functionality. Difficult-to-digest foods can tear the intestinal wall resulting in the escape of toxins and other potentially harmful particulates into the bloodstream. Regular consumption of hard-to-digest foods can lead to chronic inflammation resulting in the development of serious conditions such as chronic disease and autoimmune dysfunction.
By eliminating foods that cause damage to the gut and continually trigger immune responses, gut health, and thereby total wellness, may be improved. Decreasing consumption of carbohydrates and processed foods, gluten, and refined sugars relieves stress on the gut allowing it time to regenerate and stabilize. In addition to eliminating certain products, there are other practices that should be incorporated into your diet to further support gut function.
Eating a large of amount of healthy protein, which is needed in the creation of immunoglobulin, bones, tendons, and tissue, is less stressful on the gut and promotes greater bodily wellness. Consuming healthy fats that are more easily absorbed into the bloodstream through the digestive tract is also another way to relieve intestinal stress. Eating greener, leafy vegetables that are nutrient dense and increase production of healthy anti-inflammatory substances, as well as purchasing and using probiotic supplements and fermented foods
Dr Muhammad Ayyub, MRCP (UK), FRCP (Edin), FACG . Consultant physician & Gastroentrologist at National Hospital, Lahore, says that “The Gut/Brain Axis is a very well-known medical entity. And many psychological diseases or organic diseases involve the gut. The most common example is the Irritable Bowel System (IBS), which has many varieties. There is a deep relation with the brain for these diseases, many hormones in the brain affect the gut. To treat the patient, we first have to reassure the patient that they don’t have any terminal illness or psychiatric illness. So the first part of this is psychological treatment. Then, we change their diet according to the disease. Depression has many manifestations, because of these the patient has an unhealthy life. There is lack of sleep, feeling of being unwell, with some people feeling like crying etc. The Gut is involved in this because the patient has mood swings causing them to have a bad diet. Either they eat very little or they eat excessively. For acute depression the patient will have to take medicines.”
Without energy the body cannot function. To acquire energy the body absorbs nutrients from the surrounding environment in the form of food. When any food is ingested, it passes through the gut to be broken down and absorbed into the bloodstream where it is then transported and utilized by the appropriate system. The gut contains a semi permeable barrier known as the gut lining that is critical to nutrient absorption and protection. When the gut is not capable of proper digestion, large molecules and partially digested food can harm the intestinal lining and leak into the bloodstream. This causes an immune response that may result in symptoms such as inflammation, discomfort, brain fog, etc.
Prof Dr Aftab Asif; MBBS, MRCPsych (London). Chairman/ Head of Dept Psychiatry & Behavioral Sciences. Owner of NARI Clinic, Lahore, states: “We know about the illnesses of the body, and we also know about the illnesses of brain, like worries, anxiety and depression . But there is another thing regarding the body and mind relationship. When we are upset by various factors that could for instance be financial or family based and we don’t want to think about it or accept it, this blockage moves towards bodily ailments e.g. the most common IBS and a much neglected or treated psychiatric illness like depression. Therefore physical ailments come forth when the mind is suffering. People become obsessed with what is wrong with the body, rather than pin pointing what is happening in the mind (as the former could just be a side effect). In villages and cities, many people acquire pains in different parts of the body. They go to hakeems or from one physician to and another, and it is very difficult to get them to see a physiatrist. Good physicians pinpoint and recognise the actual problem and give the right antidepressents and anti-anxiety medication, and the patients improve . But do these physicians know about all the psychiatric illnesses? This becomes a controversial topic.
“In general, a healthy diet is one that’s high in fiber, moderate in protein, and low in fat, with minimal processed foods or toxins,” noted. Dr. Lisa Ganjhu, clinical assistant professor of medicine at NYU Langone Medical Center. She further recommended whole grains; fresh, bright fruits and vegetables; low-fat dairy; lean meat proteins, such as fish, chicken, and turkey; vegetable proteins such as soy, legumes, and beans; omega-3- rich meals, including fatty fish. She emphasized the importance of staying hydrated with water, green tea, or low-sugar juices and eating enough fiber, which not only keeps the gastrointestinal tract moving, but also nourishes and energizes the cells of the colon. Dr. Ganjhu advised limiting the intake of red and processed meats as well as substances high in sugar, caffeine, or alcohol.
“Eat the right balance of Omega-3 to Omega-6 fats. – Too many Omega-6 fatty acids can lead to inflammation and exacerbate digestive problems. A huge step in this direction can be made if you eliminate seed-based yellow cooking oils (corn, soybean, vegetable , canola , etc.) from your diet and begin cooking with more traditional fats like butter from grass-fed cows, coconut oil, and ghee. Eat foods naturally rich in Omega-3 fats like wild caught fish. You’ll also want to eat meats and dairy from pastured/wild/grass-fed animals. Eat more homemade soups & stocks. Eat more fermented & living foods. — Old-fashioned, pickles, chutneys, and fermented dairy products like buttermilk, sour cream, & yogurt (all made via natural fermentation with good bacteria) help repopulate the gut with good bacteria, supplemented by probiotics and fermented cod liver oil. —These two supplements combine to form a veritable power-house that promotes intestinal healing. Probiotics help repopulate the gut with good bacteria while the Omega-3s and vitamins A & D in the fermented cod liver oil help reduce inflammation and supply the gut with what it needs to heal.” states Dr Ganju.
Processed foods can cause inflammation in the lining of our GI tract, the exact place where food is absorbed. Your gut may not recognize what you’ve eaten as digestible food and instead interprets the presence of foods like artificial ingredients as an “attacker.” This sets off an inflammatory response in which our bodies are literally fighting these foods as if they were an infection. Sticking to more whole foods, such as whole fruits, veggies, and unprocessed meats, can lower the stress this creates on your body.
Other methods are to reduce and manage stress. This could mean taking a few minutes for meditation, a relaxation exercise, or time for yourself each day. Avoid the urge to eat “comfort foods” that may not be good for you. Stay active and avoid tobacco. Avoid sugar and starches. —Bad bacteria thrive on sugar. It is their food of choice. You shouldn’t eat any refined sugar, and you should greatly reduce the amount of starches you eat.
Ayesha Khan is an eminent leading clinical nutritionist of Pakistan who has been practicing at DHMC and Al Razi Lahore over past one and a half decade. She says, “If you truly ask a nutritionist, the gut and the brain are actually interlinked. No wonder it has been commonly observed that some people quote certain incidents as “gut-wrenching” experiences; while for some certain emotional situations make them feel nauseous. Moreover most of us have butterflies in our stomachs because of certain encounters. Actually the gastrointestinal tract is sensitive to emotions and our thinking. Both are intimately connected. In fact, the gut has been many a times referred to as the ‘second brain’. There is this vagus nerve i.e, a two-way information highway that connects 200-600 million nerve cells between our intestines and brain thereby developing a strong linkage between gut and mental state. Digestive system and the brain are linked through a powerful pathway known as the Gut-Brain Axis, made up of nerves, hormones and the immune system. At times, a lack of serotonin reuptake and less production of dopamine can trigger depression. It has thus rightly been said that a healthy mind keeps a healthy body and vice versa. It has been widely observed that people prone to IBS tend to show both way linkage between gut and brain health. In current times, even in a county like Pakistan, an unseen anxiety and depression is prevalent in many people and it has been seen that their unhealthy gut acts as a trigger to aggravate the deep lying ill health in them.
Creating a healthy gut microbiota is being investigated as a treatment strategy for serotonin-related brain-gut axis disorders. Healing the gut is not an overnight process. Correct environment for probiotics is required to be created. Simple and subtle adjustments, including eating probiotic rich foods can begin to lay a good foundation for change. For my clinical experience working as clinical nutritionist with IBS patients, diet changes that result in a calmer gut appear to impact overall quality of life. Food and its ultimate resting place, the gut, no doubt both play a significant role in at least easing depression, if not curing it altogether. Responsible for this are biochemical processes and the release of so-called happiness hormones. The most popular ones are endorphins, dopamine and serotonin. Incorporating prebiotics, omega 3 rich foods, vitamin D3 and certain types of B complex actually help in controlling the situations. The second important thing to note here is that ‘moderation’ and appropriate usage of right nutrients is required. Balanced nutrition is the key factor. Moreover, refined sugars and processed foods need to be avoided. Last but not the least, you must consult qualified nutritionists making individualised plans to deal with every unique situation.
