Gut/Brain Connection Update

Gut/Brain Connection Update
by Bonnie Minsky MA, MPH, CNS, LDN and Steve Minsky

Opening Remarks
Attention deficit hyperactivity disorder is a label we now give 8.7% of children between the ages of 8 and 15 years. Over 1 in 10 children take stimulant medications. Autism affects 1 in 166 children. Major depression has a lifetime prevalence of 1 in 10. Alzheimer’s disease will affect 30% of people over 85 years old and is expected to rise three-fold by 2050. Psychiatric or psychotropic medications are the number two–selling class of prescription drugs. Taken as a whole, depression, bipolar disease, anxiety, panic disorder, posttraumatic stress disorder, psychoses, attention deficit disorder, autism, Alzheimer’s, and more pose a significant burden to society in terms of individual suffering, loss of optimal social functioning, and economic costs.

Could it be that we are looking in the wrong place for the answers to our epidemic of neurological and psychiatric disorders? Could it be that our psychotropic medications attempt to control the smoke while ignoring the fire? Could it be that these are, in fact, not primary brain disorders at all, but systemic disorders that affect the brain? And could it be that therapies primarily aimed at altering brain function through antidepressants, stimulants, anti-psychotics, and seizure medications may miss the primary mechanisms or disturbances that manifest as behavioral, mood, or neurologic symptoms? Aside from the fact that recent studies question the effectiveness of antidepressants, conventional medicine is becoming more convinced that the communication between the brain and the body is bi-directional and that although mind-body medicine has been studied and accepted as legitimate, it provides only a one dimensional view of the interaction between brain and body. (Excerpts from an editorial written by Mark Hyman, MD for the Nov/Dec 2007 issue of Alternative Therapies in Health and Medicine.)

Gut as the Second Brain: Thinking Out of the Box.
Our gastrointestinal tract acts as a "second brain." Think of the brain in our skull as the North and the enteric nervous system that hides in our gut as the South. The connection between the brains lies at the heart of myriad maladies, physical and psychiatric. Ailments such as anxiety, depression, irritable bowel syndrome, ulcers and Parkinson's disease manifest symptoms at the brain and the gut. British Journal of Hospital Medicine has gone so far to acknowledge the connection by calling recurrent abdominal pain, "the abdominal migraine."

Many doctors will admit that the majority of patients with anxiety and depression also have alterations of their GI function. The role of the South Brain is to manage every aspect of digestion, from the esophagus to the stomach, small intestine and colon. The South Brain accomplishes this with the same tools as the North Brain, a sophisticated nearly self-contained network of neural circuitry, neurotransmitters and proteins. Consequently both brains are affected by many of the same things.Where do the problems begin? Poor diet and psychological trauma for starters. Chronic gut disorders are integrally linked to poor dietary lifestyle and/or early childhood traumas like parents' divorces, chronic illnesses or parents' deaths. What happens early in life from a dietary and psychological standpoint, along with an individuals genetic background, programs how a person will respond for the rest of his or her life.

Research at a Glance: Psychological Burden of Gut-Brain Interaction

• The Psyche and the Gut: Research on gut-brain interactions has increased over the last decade and appear with a frequency of 1% to 3% in leading gastroenterological journals. Increasing focus underlines the importance of enhancing our understanding on how the psyche and the brain communicate in order to better meet the needs of our patients. World Journal of Gastroenterology 7/07
  
  
• The prevalence of headache is higher in people with gastrointestinal symptoms such as nausea, acid reflux, diarrhea, and constipation. Cephalalgia 2/08
  
  
• Dietary influences on cognitive development and behavior in children: For children showing behavior problems such as hyperactivity the use of dietary manipulation tends to be a more acceptable approach to treatment than the use of drugs. Proceedings of the Nutrition Society 2006
  
  
• There now exists a substantial amount of evidence that depressed patients show signs of gut immune activation including increased levels of proinflammatory cytokines and the peptide leptin. Both can induce anhedonia, one of the cardinal symptoms of depression. Brain, Behavior, and Immunity 2/07
  
  
• The brains in women who suffer from irritable bowel syndrome may be unable to tamp down the pain response, leaving them more vulnerable to the intestinal discomfort that characterizes the disease. Journal Neuroscience 1/08
  
  
• Beside its role as a neurotransmitter in the central nervous system, serotonin appears to be a central physiologic mediator of many gastrointestinal (GI) functions and a mediator of the brain-gut connection. By acting directly and via modulation of the enteric nervous system, serotonin has numerous effects on the GI tract. Better understanding of the role of the serotonin receptor subtypes and serotonin mechanisms of action in the liver and gut may open new therapeutic strategies in hepato-gastrointestinal diseases. Cell Molecular Life Science 12/07
  
  
• A robust relationship between psychosocial factors and atopic disorders exists. The major atopic disease assessed in these studies was asthma (90.7%) with allergic rhinitis, 4.7%; atopic dermatitis, 2.3%; and food allergies, 2.3%. The overall results exhibited a positive association between psychosocial factors and future atopic disorder as well as between atopic disorders and future poor mental health. Psychosomatic Medicine 1/08
  
  
• It is important to acknowledge the complex interplay between body and mind: Adults and children suffering from food allergy show impaired quality of life and a higher level of stress and anxiety. World Journal of Gastroenterology 7/07
  

What You Can do to Help Yourself.
Pinpoint the Problem.

#1 - Screen for Food Intolerances/Allergies.
Most of us know if we have a true food allergy. These are immediate, catastrophic inflammatory responses to foreign proteins in foods or substances that we ingest (commonly known as anaphylaxis). It is estimated that 12 million Americans suffer from true food allergies.

However, many of us are unaware of what approximately 72 million Americans suffer from: food intolerance. If our practice is any indication, we think the number of Americans with food intolerance is much higher than estimated.

Food intolerances are most indicated in individuals with inflammatory bowel problems which can include eosinophilic esophagitis, Crohn's disease, ulcerative colitis, and irritable bowel syndrome. Additionally, those with rheumatoid arthritis, osteoarthritis, post-traumatic arthritis, fibromyalgia, and migraines often have food intolerances.

Simply, when an intolerant food is presented to the digestive system, it has a toxic effect at the cellular level. Gluten intolerance is a perfect example of how a substance, in this case, the glue that holds grain together, attacks the cells in our digestive tract and creates a host of adverse effects. As the toxicity becomes more pronounced (cells begin to die or under perform), this is when we contract chronic conditions.

In our estimation, roughly 40% of our clientele have food intolerances. In most cases, if the food triggers are not discovered in the first few appointments, we run a Food Intolerance (Cytotoxic) blood test that covers 209 foods, spices, and preservatives. We have used the same lab, Biotrition in Rolling Meadows, for many years because their results are accurate and consistent. One of my colleagues, respected allergist Dr. Robert Boxer, has been using this test even longer.

A study that appeared in the January 2007 issue of journal Nutrition & Food Science followed 5,286 subjects reporting a wide range of chronic medical conditions, who had taken a food-specific IgG enzyme-linked blood test. Of patients who rigorously followed the diet, 75.8 per cent had a noticeable improvement in their condition. Of patients who benefited from following the recommendations 68.2 per cent felt the benefit within three weeks. Those who reported more than one condition were more likely to report noticeable improvement. 81.5 per cent of those that dieted rigorously and reported three or more co-morbidities showed noticeable improvement in their condition. For those who dieted rigorously and reported high benefit, 92.3 per cent noticed a return of symptoms on reintroduction of the offending foods. These data provide evidence for the use of elimination diet based on food-specific IgG blood test results as an aid to management of the symptoms of a range of chronic medical conditions.

In February of 2007, another study focusing on food intolerance was published. It was a resounding success and mirrored almost to the letter how Nutritional Concepts' treats food intolerance. Please read our analysis of 2/07 study.

Contact our office if you suspect that your neurological and/or gastrointestinal issue(s) may be related to food intolerance and would like to explore your options.

Research at a Glance: Link Between Food Intolerance/Allergy and GI Disorders

• According to a recent study in the January 2008 issue of Annals of Allergy, Asthma Immunology, patients with allergies have a significantly greater incidence (over 20%) of Irritable Bowel Syndrome than those without allergies. The lead researcher of the study adds that identifying the allergic triggers, both inhaled and ingested, and applying the appropriate treatment can markedly improve the patients quality of life in controlling IBS.
  
  
• Treating Irritable Bowel Syndrome in the Intestinal Bowel Disorder outpatient, with emphasis on using a food and beverage intolerance, avoidance diet. The adverse effects of many foods and beverages are amount dependent and can be delayed, additive, and cumulative. The specific types of foods and beverages that can induce IBS symptoms include milk and milk containing products; caffeine containing products; alcoholic beverages; fruits; fruit juices; spices; seasonings; diet beverages; diet foods; diet candies; diet gum; fast foods; condiments; fried foods; fatty foods; multigrain breads; sourdough breads; bagels; salads; salad dressings; vegetables; beans; red meats; gravies; spaghetti sauce; stews; nuts; popcorn; high fiber; and cookies, crackers, pretzels, cakes, and pies. Journal inflammatory Bowel Disorders 1/07
  

#2 - Limit Additives/Preservatives/Medication Consumption.
Many of you are aware of the 'toxic potential' of additives and preservatives. While MSG (monosodium glutamate), food dyes/colorings, and sulfites are well-known, we are hearing more about the effects of artificial sweeteners, benzoates, mold and bacteria, antibiotics and other medications, vaccines, genetically modified foods, viral adulteration/irradiation of our food supply, etc. Please be vigilant about recognizing the connection between these substances and altered gut/brain function.

#3 - Screen and/or manage Gluten Intolerance, Celiac Disease, Ulcerative Colitis, Crohn's Disease, and other GI diseases.
Screening for Gluten Intolerance/Celiac is becoming much more common with physicians, but is still frequently misdiagnosed or ignored. Additionally, those with celiac disease on a gluten-free diet may still have gastrointestinal symptoms. The cow's milk (CM) protein casein, in particular, seems to be involved in this reaction, according to the March 2007 issue of Clinical and Experimental Immunology.

For those who suspect other gastrointestinal conditions, see a GI specialist for proper diagnosis. Then see a licensed dietary professional for food modifications.

#4 - Screen for yeast imbalance.
A yeast overgrowth/imbalance throws off normal function of the GI tract. Detection of a yeast imbalance can be obtained through the Biotrition Food Intolerance test, or through a separate Candida test that can be ordered by your health professional.

#5 - Screen for Virulent Pathogens and Superbugs.
A stool culture can detect pathogens and superbugs that wreak havoc on the GI tract. Unfortunately, as they are becoming more and more resistant to current medication, the effects of E.Coli, Salmonella, Staphylococcus Aureus, and Clostridium Difficile are often catastrophic.

#6 - Eliminate or prevent gastrointestinal reflux.
Long-term GER/GERD medication can be detrimental to the gut and brain.


What You Can do to Help Yourself.
Incorporate Positive Diet and Lifestyle Changes.

We always suggest working with your health professionals to seek the proper path for your individual needs.

The Healthy Gut/Brain Paradigm:

1. Create an optimal diet and nutrient lifestyle.
Emphasize the removal of sugar and food chemicals from your diet. Infuse your body with a nutrient regimen suited to your individual needs. Our best self-help diet is the Pain Relief Diet Action Plan. It removes many of the dietary triggers that cause GI distress and the two week menu allows the implementation of the Four Rs:

Relax - give the gut time to relax with no trigger foods.
Repair - the gut has a miraculous ability to heal itself if given the time and the right fuel.
Repopulate - infuse healthy flora with probiotics.
Resume - incorporate a less restrictive, balanced dietary lifestyle to fit your individual needs.

2. Apply stress reduction techniques.

3. Aim for optimal emotional balance through conventional, medication-free psychiatric counsel or, if needed, psychopharmacology.

4. Utilize complementary therapy such as Chiropractic or Acupuncture.


What You Can do to Help Yourself.
More Nutrient-Intensive Therapies at a Glance.

Rapid recovery from major depression using magnesium treatment.
Magnesium deficiency is well known to produce neuropathologies. Only 16% of the magnesium found in whole wheat remains in refined flour, and magnesium has been removed from most drinking water supplies, setting a stage for human magnesium deficiency. Magnesium ions regulate calcium ion flow in neuronal calcium channels, helping to regulate neuronal nitric oxide production. In magnesium deficiency, neuronal requirements for magnesium may not be met, causing neuronal damage which could manifest as depression. Magnesium treatment is hypothesized to be effective in treating major depression resulting from intraneuronal magnesium deficits. These magnesium ion neuronal deficits may be induced by stress hormones, excessive dietary calcium as well as dietary deficiencies of magnesium. Case histories are presented showing rapid recovery (less than 7 days) from major depression using 125–300mg of magnesium (as glycinate) with each meal and at bedtime. Magnesium was found usually effective for treatment of depression in general use. Related and accompanying mental illnesses in these case histories including traumatic brain injury, headache, suicidal ideation, anxiety, irritability, insomnia, postpartum depression, cocaine, alcohol and tobacco abuse, hypersensitivity to calcium, short-term memory loss and IQ loss were also benefited. Dietary deficiencies of magnesium, coupled with excess calcium and stress may cause many cases of other related symptoms including agitation, anxiety, irritability, confusion, asthenia, sleeplessness, headache, delirium, hallucinations and hyperexcitability, with each of these having been previously documented. The possibility that magnesium deficiency is the cause of most major depression and related mental health problems including IQ loss and addiction is enormously important to public health and is recommended for immediate further study. Medical Hypotheses 3/06

Cod Liver Oil Linked to Less Depression.
Regular and long-term intake of omega-3 fatty acid-rich cod liver oil may protect people from symptoms of depression, says a large study published in the June 2007 issue of Journal of Affective Disorders. In 21,835 Norwegian subjects aged between 40 and 49 and 70 and 74 years, the prevalence of depressive symptoms was 29 per cent lower in regular cod liver oil users than the rest of the population. "In this large population based cross-sectional study we found that daily use of cod liver oil was negatively associated with high levels of depressive symptoms and that the prevalence of such depressive symptoms decreased with the duration of cod liver oil use," wrote lead author Maria Baroy Raeder from Haukeland University Hospital. The length of regular cod liver oil supplementation was found to influence the prevalence of high levels of depressive symptoms - the longer the duration of supplementation, the lower the prevalence of symptoms of depression.

Mediterranean diet wards off asthma, allergy.
Children of women who eat a Mediterranean diet rich in fruits and vegetables while pregnant are far less likely to develop asthma or allergies later in life. Eating vegetables more than eight times a week, fish more than three times a week and legumes more than once a week seems to boost the protection, the researchers said in the January 2008 issue of journal Thorax.

Role of probiotics in correcting abnormalities of colonic flora induced by stress.
Probiotics organize gut microflora for better regulation of the HPA axis not only in the early years but also during adulthood. It is suggested that daily environmental and emotional stressful life events contribute to the development and reactivation of intestinal inflammation in chronic inflammatory bowel disease (IBD), to the clinical manifestations of irritable bowel syndrome (IBS) and to the development of food allergies by sensitization of intestinal tissue to oral antigens. Neuro-Gastroenterology and Nutrition Unit, Toulouse, France


What You Can do to Help Yourself.
Spring Allergy Season Tips.

Allergy season begins mid-April. Many of you see an exacerbation of neurological and digestive symptoms during this period. If you have environmental allergies, food allergies, and food intolerances, it would be a good idea to get into preventative mode now. You need to start thinking about foods that cross-react with environmental allergens.

According to the February 2008 issue of journal Current Opinion in Allergy & Clinical Immunology, immunologic cross-reactivity, which is important in many aspects of host defense and immune-mediated diseases, is a prominent feature of allergic disorders. Recent evidence suggests up to one-third of people with seasonal allergies may suffer oral allergy syndrome (OAS), which results from a cross-reactivity between seasonal airborne pollen proteins from weeds, grass and trees and similar proteins in some fresh fruits, vegetables, and grains leading to distinct clinical reactions. Common symptoms of OAS -- also known as pollen-food syndrome -- include: itchiness, tingling or swelling of the mouth, tongue and throat immediately after eating fresh fruits, vegetables and certain kinds of other foods, according to the American Academy of Allergy, Asthma & Immunology. People with ragweed pollen allergies might experience symptoms if they eat foods such as bananas, cucumbers, melons, zucchini, sunflower seeds, chamomile tea and Echinacea. People with birch tree pollen allergies may experience OAS symptoms if they eat food such as peaches, apples, pears, cherries, carrots, hazelnuts, kiwi fruit or almonds.

Here are some quick tips:

• Supplement with Probiotics - reduces intestinal inflammation related to allergic response.
  
• Supplement with a quercetin-intensive antioxidant complex such as Allergy Fighters.
  
• Supplement or consume inflammation-reducing omega-3 fish oil.
  
• Supplement with magnesium for cellular health.
  
• Reduce or eliminate all refined and added sugars, which suppress the immune system and degrades cell health.
  
• Minimize consumption of your most common food allergens/intolerants.
  
• Refer to our Food Allergy Handbook for the entire list of spring cross-reactors and much more.

Conclusion
We have seen it clinically time and again. If the South brain heals, the North brain follows suit. It is much more difficult to accomplish this the other way around.

But don't take it from us. As you have read, the conclusion from the science is irrefutable and must be heeded to effectively address the epidemic of “brain” diseases. Unless we focus on the metabolic, nutritional, and environmental influences that exert their effects on the brain through the body, we will not succeed in our efforts to promote mental and cognitive well-being. The new frontier is the delineation and analysis, as a whole, of all the aspects of “body” dysfunction or imbalance that lead to abnormal neurochemical signaling, altered behavior and mood, and neurodegeneration. The model incorporates understanding of the role of nutritional deficiencies, hormonal imbalances, inflammation, altered immunity, toxins, oxidative stress, mitochondrial dysfunction, altered cell bioenergetics, and digestive dysfunction in altered behavior, mood, and brain function. It is only by teasing apart how each of these fundamental physiological processes alters brain function and studying how correcting them can restore normal function that a new model of psychiatry, neurology, and clinical neuroscience can emerge that provides more satisfactory answers than only partially effective pharmacologic treatments.

The paradox is that the answer will not be found in the detail of any one pattern or system of physiologic disturbance. It is only in the putting together of all the pieces of the puzzle, in the assessment and treatment of all disordered systems simultaneously that true advances can occur. (Excerpts from Nov/Dec 2007 Alternative Therapies in Health and Medicine)

© 2007 Nutritional Concepts, Inc.