What's Your Gut Say?

Biloxi, Mississippi, 1972. Photo by William Eggleston. 

Biloxi, Mississippi, 1972. Photo by William Eggleston. 

I tend to shy away from asking my clients much about their diets because food can be such a fraught topic. Personally, any suggestion of diets or food limitation turns me off and I guess I try to spare them from this. I was raised with a Western approach to health, in which body and mind are treated as separate issues, and I'm guilty of defaulting to this mode of thinking. For example, I don't give much consideration to how the food I eat affects me, especially not my mental health. 

However, I am in the continued pursuit to further my understanding about the mind and body and how they work. This post is my personal attempt to challenge my own system of denial (my favorite coping mechanism) and turn toward a more holistic approach, acknowledging the important and intricate connection between our diets and our mood. We are learning so much about our gut health and the connection to everything else in our body, so this will just be touching the surface of a robust conversation. 

The New Biology of Depression
The idea that depression and other mental health conditions are caused by an imbalance of chemicals (particularly serotonin and dopamine) in the brain is so deeply ingrained in our collective psyche that it seems almost sacrilegious to question it. 

Of course, Big Pharma has played a role in perpetuating this idea. Antidepressant drugs, which are based on the chemical imbalance theory, represent a $10 billion dollar market in the U.S. alone. Antidepressant prescribing has risen nearly 400% since 1988, according to data from the Centers for Disease Control and Prevention (CDC). More than 1 in 10 Americans over age 12 now takes an antidepressant, the study finds, and yet more than two-thirds of those with symptoms of depression have not seen a mental health professional in the past year. 

If you’ve been diagnosed with depression, your doctor may have said that you’re “just born that way.” And you may worry that having a depressed family member means that you’ll get depression too.

However, gamechanging science is showing that our destinies are not written in our genes. What if depression isn’t caused by a “chemical imbalance” after all? More specifically, what if depression itself is not a disease, but a symptom of an underlying problem? 

That is exactly what the most recent research on depression is telling us. A new theory called the “Immune Cytokine Model of Depression” holds that depression is not a disease itself, but instead a “multifaceted sign of chronic immune system activation.”

To put it plainly: depression may be a symptom of chronic inflammation in the body.

The Brain - Gut Connection
We have all experienced the connection between our mind and our gut -- the decision we made because it “felt right,” the butterflies in our stomach before a big meeting, the anxious stomach rumbling we get when we’re stressed out. While the dialogue between the gut and the brain has been recognized by ancient healing traditions, including Ayurvedic and Chinese medicine, Western medicine has by and large failed to appreciate the complexity of how the brain, gut, and more recently, the gut microbiota -- the microorganisms that live inside our digestive tract -- communicate with one another.

We are all at risk for chronic, silent inflammation. We eat foods that are processed beyond recognition, are sitting inside offices and cars most of the day, and are exposed to thousands of modern chemicals. Inflammation is the result of these types of conflicts. Usually we recognize inflammation, a signal that something is wrong, by pain. However, because the brain does not have pain receptors, it’s difficult for us to know when our brains are inflamed.

When a potential threat is sensed in the gut, large, far-reaching inflammation occurs. This inflammation can travel directly from your gut to your brain, especially through the vagus nerve.

The vagus nerve is the longest nerve stemming from the brain. The vagus nerve is a two-way information highway that connects 200-600 million nerve cells between our intestines and brain. While it’s best to manage stressors to reduce stress-related symptoms, like depression, one of the most direct and quick ways to calm the vagus nerve is through dietary change. Just as emotions send messages to your gut, food sends messages to your brain. 

How does food create inflammation?
Inflammation is the language your body uses to express displeasure. There are many drivers of gut inflammation that lead to depressive symptoms. When we eat highly processed foods, which are foreign to our body, our gut cells set off the alarm of inflammation. Further, many people are unknowingly eating inflammatory foods like gluten and dairy that cause allergenic reactions too mild for most people to notice. Sugar, artificial sweeteners, and casein proteins (found in dairy) have been shown to activate inflammation. 

Beyond food, many people pop pills without thinking about what they do to their bodies. It's common for us to down a daily cocktail of "harmless" drugs including Tylenol, antibiotics, acid blockers, and birth control pills. 

Consuming processed, nutrient-poor foods and pharmaceuticals can radically change the gut microbiome. Alterations in the microbiome, called dysbiosis (or “wrong living,”) can lead to intestinal permeability, or leaky gut. Leaky guts allow substances to leak into the bloodstream and fans the flames of inflammation and depression. 

Other stress reduction strategies, such as physical activity, adequate levels of sleep, social support/connection, and mindfulness/meditation practice will also reduce inflammation in your body. If you're interested, try to start paying attention to the subtleties of how your body feels throughout the day and maybe experiment with these ideas. It can be helpful to have a community of support when making these changes, so let me know how it goes! 

I'm beginning with this smoothie (see notes in the comments about what kind of collagen to get). It's more medicine than milkshake going down, but it's so satisfying that the thought of food doesn't cross my mind for hours and I feel a buzzy, energetic sensation in my brain and body. UDATE: Two weeks later and I crave this freakin smoothie. With this and other dietary changes, I'm surprised at how quickly my cravings and palate can change. 

For more information: 
Kelly Brogan, MD 
Chris Kesser, MD