For a long time, mental health has been mainly viewed as being cerebral, with the body just being a way to evacuate whatever is going on in our heads. However, recent research & evidence has shown that mental health problems aren't strictly mental - it's also physiological. Has anyone ever told you (infuriatingly) "it's all in your head"? Well, now you can quip back: "actually, it's also in my gut."
The gut is frequently referred to as our "second brain". We are constantly using hyperboles to refer to strange sensations in our stomach: feeling butterflies, having a gut reaction, feeling sick to our stomach, or experiencing something "gut wrenching"... This is not by accident! Our gut is very sensitive and quick to react to our emotions. In fact, Dr. Michael Gershon, dubbed the "father of neurogastroenterology", has written a book with that exact title: The Second Brain: A Groundbreaking New Understanding of Nervous Disorders of the Stomach & Intestine. The powerful connection between mind and body, and the effects that mental health has on our physical health is truly mind-boggling - and we haven't even begun to fully understand its intricacies.
Here's the low-down on what we already know.
The MGB axis (the term coined for the two-way communication between the Microbiota (also known as gut flora, or the bacteria residing in your gut), the Gut and the Brain) can influence the prevalence of disease in humans, including anxiety and mood disorders. How? Well, as mentioned above, it's a two way street between the gut and the brain: what affects one affects the other. When you experience anxiety, external stressors, etc..., stress hormones are released and affect the composition of your gut flora, causing digestive issues and stomach upsets. This alteration causes your gut to become more permeable, allowing the "bad" bacteria to seep in and cause stomach distress and irritability. In turn, 90% of seratonin (!) (an incredibly important neurotransmitter that greatly affects and regulates mood, among other crucial elements such as appetite and sleep) and 50% of the body's dopamine (a neurotransmitter & hormone central to our reward system, motivation, mood and motor control, for example) are created in the gut. So if your gut is out of wack, your serotonin levels are likely to take a serious nose dive - a reason as to why mental health issues such as depression and anxiety are prevalent in those with irritable bowel syndrome (IBS) and Crohn's disease, for example. It's not uncommon for gastroenterologists to prescribe anti-depressants or suggest therapeutic approaches such as Cognitive Behavioral Therapy (CBT) for clients suffering from IBS & Crohn's for the purpose of calming painful symptoms through acting on the 500 million plus (!) nerve cells in the gut.
In a nutshell: your mood greatly affects your gut flora, and your gut flora greatly affects your mood. Sounds simple enough, but the ins and outs of it are never ending!
The question here is, what can we do about it?
Unfortunately, there is no simple or straight answer. We're all wired uniquely and respond to external and internal factors differently. A situation that could, for example, make me extremely anxious and upset my stomach could have no affect whatsoever on you, and vice-versa. However, there are a couple of "guidelines", or rules of thumb, that seem to work for most people. Remember, gut health goes hand in hand with our mental wellbeing, so working on just one aspect, such as diet, is a great start & will unequivocally yield results, but should be supplemented with the second aspect at some point, if not right away.
1. Breathing This may sound a bit strange, but go with me here. Diaphragmic breathing, also known as "abdominal breathing", is key for digestive health and for stress reduction. Other benefits include reducing muscle tension, increasing blood flow, improving concentration, increased energy, and reduced stress hormones.
The University of Michigan Medical School published an article (linked above) on the overall benefits of diaphragmic breathing, but also on the specific benefits for those suffering from gastrointestinal issues, citing:
Activating the diaphragm creates a gentle massaging action felt by internal organs like the intestines and stomach, which can reduce abdominal pain, urgency, bloating and constipation. While diaphragmatic breathing, you are facilitating the activation of the parasympathetic system, which can be thought of as the relaxation response of the body or the “rest and digest” state.
Harvard Health suggests the following as a "how to" for diaphragmatic breathing:
Lie on your back or a flat surface with your knees bent. You can use a pillow under your head or knees for support.
Place one hand on your upper chest and the other one on your belly, just below the rib cage.
Breathe in slowly through your nose, letting the air in deeply, towards your lower belly. The hand on your chest should remain still, while the one on your belly should rise.
Tighten your abdominal muscles and let them fall inward as you exhale through pursed lips. The hand on your belly should move down to its original position.
Another breathing technique, one that I frequently refer my clients who suffer from anxiety and/or sleep issues to, is called the 4-7-8 Relaxation Exercise, and was developed by Dr. Andrew Weil. It goes as follows:
Exhale completely through your mouth, making a woosh sound.
Close your mouth and inhale through your nose to a silent count of 4.
Hold your breath for a count of 7.
Exhale completely through your mouth, making a woosh sound for a count of 8.
Exhale & repeat three more times, for a count of 4 breaths.
Learning how to breathe deeply and mindfully can be a saving grace for GI tract and mental health issues. The best part of all is that it's accessible to everyone, it's not time consuming, there are absolutely no side effects and it's completely free. It's a complete win-win.
Finally, here are a couple of great Youtube videos on the subject that I have found to be helpful:
Belly Breathing for Good Gut Health by Laya Healthcare
and, for breathing and movement:
Yoga for Bloating, Digestion, Ulcerative Colitis, IBD and IBS by Sarah Beth Yoga
2. Mindfulness Mindfulness Based Stress Reduction was created by Jon Kabat-Zinn at the UMass Medical Center in the late 1970s. It's the act of being present and aware in this moment without judgement. The American Psychological Association (APA) defines mindfulness as having two aspects - or pieces - to it:
The attention piece is about tuning into your experiences to focus on what's happening in the present moment. It typically involves directing your awareness to your breath, your thoughts, the physical sensations in your body and the feelings you are experiencing. The acceptance piece involves observing those feelings and sensations without judgment. Instead of responding or reacting to those thoughts or feelings, you aim to note them and let them go.
Mindfulness has proven, time and time again, to be crucial to stress management, reducing symptoms of depression, anxiety and post-traumatic stress disorder (PTSD), and even helpful in the handling of chronic pain, psoriasis and alleviating headaches.
Many of us (myself included!) are guilty of eating quickly due to the "fast pace" lifestyles we have grown accustomed to in Western society. On a very basic level, practicing mindfulness on a day-to-day basis "forces" us to slow down, which, as a result, positively impacts our digestion by simply slowing down our eating, allowing us to not only enjoy our food and make more conscious decisions about what we are putting in our bodies, but also facilitating digestion through the "simple" act of chewing slowly.
Harvard Medical published an article that suggests the following tips for mindful eating:
Set your kitchen timer to 20 minutes, and take that time to eat a normal-sized meal.
Try eating with your non-dominant hand.
Use chopsticks if you don't normally use them.
Eat silently for five minutes, thinking about what it took to produce that meal, from the sun's rays to the farmer to the grocer to the cook.
Take small bites and chew well.
Being mindful in your day-to-day, including while eating, will not only improve your digestion, it will help you with managing your anxiety, symptoms of depression and create self-compassion, among many other things. I'll be writing a more detailed blog post about this in the upcoming weeks, but in the meantime check out two of my favorite Mindfulness apps, HeadSpace and Calm. They both offer free trials (2 weeks & 1 week, respectively) for new members, and are quite affordable thereafter. Trust me - your mental health will thank you.
3. Probiotics The word "probiotic", interestingly enough, is derived from the Latin word "pro"and the Greek word "biotikos", roughly translating to For Life. Recent research has shown that incorporating probiotics into our diet can restore the gut flora, and therefore have a hugely positive impact on your mental and physical health. There are two ways you can take in probiotics: Through Food: Fermented & cultured foods are SO great for your digestive system. Sauerkraut (sour fermented cabbage), kimchi (spicy fermented cabbage), kefir (fermented milk), yogurt (particularly greek yogurt), pickles, miso, tempeh, and pickled veggies. Through Supplements: If you're not keen on adding fermented foods into your diet, there are a variety of good quality over-the-counter probiotic supplements. You can find them in your local pharmacy or online. My personal favorite is Garden of Life Probiotics Mood+. Not all probiotic supplements are created equal. When choosing a probiotic supplement, you want to make sure that they provide billions of probiotic cultures. Start in the low billions & work your way up (depending on your tolerance). The lowest number you'd want to start with is 30 billion. Variety is also key: check how many strains the probiotic is offering. Different strains do different things: for example, L.rhamnosus is key for increasing GABA (inhibitory neurotransmitter that, simply put, reduces our anxiety and stress), while B.lactis helps digestion and increases absorption of vitamins and minerals in the gut. Remember that some probiotics may not be suited for you, so if you have any undesirable side effects lasting beyond the time it takes for your body to get used to the probiotic, you may want to look into switching to a different brand. Harvard Medical published an article on the potential benefits of probiotics, citing a small study in 2013:
(...) women who ate yogurt with a mix of probiotics, twice a day for four weeks, were calmer when exposed to images of angry and frightened faces compared with a control group. MRIs also found that the yogurt group had lower activity in the insula, the brain area that processes internal body sensations like those emanating from the gut.
If you'd like to know more about probiotic supplements, this article provides a lot of great information.
* For most people, probiotics appear to be safe. However, if you have short bowel syndrome, are being treated for cancer, have an immune disorder, have been diagnosed with candida or short intestine bacterial overgrowth, or have any other medical condition that could be affected by the intake of probiotics, please consult your doctor before taking them to make sure they're right for you.
4. Boost Your Diet
Have you ever heard of the Anti-Depressant Food Scale? Well, I hadn't either until I started doing research for this article. This food scale is the brain child of Dr. Laura Chance and Dr. Drew Ramsey, born from a study they did. The foods that ranked highest on this list are watercress, spinach, mustard greens, lettuce, swiss chard, kale, oysters and clams. The reasoning behind this? These food items are chock full of the twelve nutrients that are crucial for mental & gut health: iron, omega-3 fatty acids, magnesium, potassium, selenium, B vitamins (B12, thiamine, folate and B6), vitamin A, vitamin C and zinc. So, while you don't have to add watercress to every meal, it's good to be aware of what foods have the above nutrients to slowly incorporate them into your diet. Other examples of foods that include these are bananas (potassium), salmon (omega-3), grass-fed lean beef (iron, thiamine & b12), avocados & dark chocolate (magnesium), eggs (vitamin A), kiwi (vitamin C), brazil nuts (selenium), and leafy greens (folate).
Simply put, the more nutrients the better. This website has compiled a list of 15 nutrient-dense, delicious recipes for you to try - I've already tucked into the chicken fajita sweet potatoes & can't wait to try out the apple kimchi salad & beef!
These four points are important for both diet, mental health, and overall wellbeing. I'll be going over these topics, in addition to many other ones, in more detail over the next few weeks so stay tuned if you'd like to know more!
Do you have experience with any of the techniques & tips listed above? What was your experience with them? Is there anything that you read here that you'd like to know more about? Let me know in the comments below or by email!
Disclaimer: I'm not affiliated with any of these brands & receive no compensation for listing them. Anything linked here is either a resource for the article or a product/service that I have tried, tested and firmly believe in.
Malan, et. al., OMICS: A Journal of Integrative Biology 2017
What Causes Depression? Harvard Health, Harvard Health Publishing 2009
Antidepressant Foods: An Evidence-Based Nutrient Profiling System For Depression Lachance & Ramsey, World Journal of Psychiatry 2018
Everything You Ever Wanted To Know About Choosing A Good Probiotic Pedre, Mind Body Green 2019
Probiotics May Help Boost Mood And Cognitive Function Harvard Health, Harvard Health Publishing
Bravo et. al., Proceedings of the National Academy of Sciences of the United States of America 2011
Mindful Eating Harvard Health, Harvard Health Publishing 2011
In The Journals: Mindfulness Meditation Practice Changes The Brain Harvard Health, Harvard Health Publishing 2011
Mindfulness Meditation: A Research-Proven Way To Reduce Stress American Psychological Association, 2019
Learning Diaphragmatic Breathing Harvard Health, Harvard Health Publishing
Diaphragmatic Breathing for GI Patients Michigan Medicine, University of Michigan
Dopamine Psychology Today
The Brain-Gut Connection John Hopkins Medicine, John Hopkins University