OUR BROKEN BRAINS AND HOW TO FIX THEM
Glynis Horning explores the connection between gut and brain
According to the only representative study done so far in South Africa (The SA Stress and Health study, 2009), almost one in every three of us will suffer from some form of mental disorder in our lifetime. But while treatment still centres on the brain, and medications for that, the roles of your gut and your lifestyle are increasingly credited as being crucial for mental health.
Dchancesepression, anxiety, Alzheimer’s, ADHD … if you or someone you know doesn’t have these or other mental health issues, you are unusual – or undiagnosed. And if you’ve been diagnosed,
are you’re on antidepressants, anti-anxiety meds or other drugs that act on the brain. But that’s the brain in your skull. What of your other brain? Today there’s increasing debate about a second brain: in your gut. As researchers at Johns Hopkins research university in the US put it: ‘Hidden in the walls of the digestive system, this “brain in your gut” is revolutionising medicine’s understanding of the links between digestion, mood, health and even the way you think.’
Scientists refer to it as the enteric nervous system (ENS): more than 100 million nerve cells that line your gastrointestinal tract from your gullet to your butt. ‘It doesn’t seem capable of thought as we know it,’ says Dr Jay Pasricha, director of Johns Hopkins Centre for Neurogastroenterology, ‘but it communicates back and forth with our big brain – with profound results.’
The ENS is believed to trigger the major mood changes experienced by many
‘Hidden in the walls of the digestive system, this “brain in your gut” is revolutionising medicine’s understanding of the links between digestion, mood, health and even the way you think.’
of us who have irritable bowel syndrome (IBS), bloating, pain and stomach upsets.
‘For decades, researchers and doctors thought anxiety and depression contributed to these problems. But our studies and others’ show that it may also be the other way around,’ says Pasricha. They are finding evidence that irritation of your gastrointestinal system may send signals to your central nervous system that trigger emotional shifts.
This could explain why a higher percentage of people with IBS and functional bowel problems develop anxiety and depression – and that’s important, because up to an estimated 40% of us experience functional bowel problems at some stage.
What’s more, say Pasricha and others, our two brains ‘talk’ to each other, so therapies that help one may help the other. But while a gastroenterologist may prescribe certain antidepressants for IBS as they ease symptoms in some cases by acting on nerve cells in the gut, some health practitioners are taking this further – suggesting diet is key for mental wellbeing. Pasricha even suggests that digestive system activity may affect cognition (thinking ability and memory), though this needs more research.
FUNCTIONAL HEALTH
A growing number of functional health practitioners is taking this new research to heart. At the forefront of the movement is Dr Mark Hyman, the director of Cleveland Clinic’s Centre for Functional Medicine, founder of The UltraWellness Centre, bestselling author and medical advisor to celebrities such as the Clintons. As he puts it, ‘Fixing your brain starts with fixing your body: optimising all the inputs and taking out the bad influences.’
Hyman and his colleagues contend that the standard western diet lacks the things our beneficial gut bacteria require to thrive – especially fibre and prebiotic foods (vegetables, fruits, whole grains), and omega-3 fatty acids. They also contend that we harm these good bacteria by eating highly processed or packaged foods, refined carbohydrates, sugars, refined oils and saturated and trans fats.
Equally damaging for our brains, they say, is taking unnecessary antibiotics (which destroy beneficial bacteria along with the bad), acid blockers for reflux, anti-inflammatories, steroids and hormones (including birth control pills); and using antibiotic soaps and alcoholbased hand sanitisers.
MAINSTREAM MENTAL HEALTH
Although many psychologists and psychiatrists support this view, they are guided primarily by the Diagnostic and Statistical Manual list of criteria, and standard treatment is antidepressant or anti-anxiety medication and/or therapy.
Accurate statistics aren’t easy to come by, but it’s been estimated that one in eight Americans over the age of 12 uses antidepressants (says the US Centers for Disease Control and Prevention), one in six 18– 64-year-old Brits (NHS Business Services Authority), and
‘Fixing your brain starts with fixing your body: optimising all the inputs and taking out the bad influences.’
a chilling one in five South Africans (according to Pharma Dynamics).
Definitive evidence of the longterm efficacy of antidepressants is not much easier to unearth in this complicated and controversial arena. A National Institute of Mental Health (NIMH)-funded study reported rates of remission (becoming free of depressive symptoms) of 31% after 14 weeks, and 65% at six months. This may seem modest (placebo response rates are often more than 30% in antidepressant trials), but in a meta-analysis, 41% of patients who were switched to a placebo relapsed, compared to just 18% who stayed on an antidepressant.
‘These studies provide compelling evidence that antidepressants are effective for some people,’ said psychiatrist and neurologist Thomas Insel, former director of NIMH (part of the largest biomedical research agency in the world). ‘Other research, especially among teenagers with depression, has found that while antidepressants can be helpful for some, it is the combination of medication and cognitive behavioural therapy that is most effective in achieving remission sooner.’
THE BOTTOM LINE FOR BROKEN BRAINS?
Insel’s conclusion is that antidepressants appear to have a ‘relatively small effect in patients broadly classified as having depression’, but in some, ‘perhaps those with more severe clinical conditions, they appear to be essential for remission’.
These people may also benefit from exploring other avenues after discussing them with their health- care professional. And for those with only mild depression, these avenues could be a first resort.
Discuss the alternative approaches too, if you have Alzheimer’s or another form of dementia. Petra du Toit, executive director of Alzheimer’s South Africa, notes that medication can now help slow the progress and control symptoms such as insomnia, restlessness, aggression and hallucinations, and antidepressants can treat the anxiety and depression. But a few lifestyle changes can impact on them too, and on your risk of developing the disease, she adds.
Sharyn McCarthy of Dementia Reach Out Programs in Ballito adds that general wellbeing is critical to having good mental health. ‘Diet, toxins, certain medications, vitamin deficiencies, pollutants, lack of exercise and high stress can all be linked to dementia/Alzheimer’s and cognitive decline.’
Many professionals working with ADHD agree. ‘Ritalin can play an important role in managing ADHD, but it’s only number 10 on the list of avenues to try, including diet and exercise,’ says clinical psychologist Robin Vanderplank, a regional coordinator for ADHASA (the Attention Deficit and Hyperactivity Support Group of Southern Africa).
‘Ritalin can play an important role in managing ADHD, but it’s only number 10 on the list of avenues to try, including diet and exercise.’