The Gut & Mental Health
A holistic approach to mental well-being
Many years ago when my daughter ended up in A&E with abdominal pain, the doctor on duty asked her about her history. When she explained that she had been given the diagnosis of IBS (Irritable Bowel Syndrome), he replied “There is no such thing as IBS”.
You might be thinking ‘What the heck?’
What he meant by this, is that ‘IBS’ is a name given to a set of symptoms. It's a syndrome and doesn't describe the cause of the abdominal discomfort or the contributing factors.
IBS can be triggered by many different things, including poor digestion, dietary triggers or food sensitivities, lack of digestive enzymes, hypochlorhydria (low stomach acid), gut dysbiosis (an abnormal balance of bacteria, viruses or fungi in the gut), thyroid issues, stress, parasites…
Therefore the diagnosis of ‘IBS’ requires further investigation.
What is it about the gut?
The gut microbiome is a complex mix of microbes that reside mostly in your large intestine and have established themselves since your birth. They are impacted by how you were born (ie whether you were born via caesarean or vaginally), your external environment (your exposure to dirt or antibacterial products), whether or not you have had antibiotics (and how much you’ve had) and probably the thing you have most - control over - what you eat.
Lack of the right balance of gut microbes can cause havoc (as you may well know if you’ve ever experienced food poisoning!)
Sometimes, however, the gut microbiome gets disturbed on a more subtle but chronic basis. This can occur due to a mix of:
A bout of food poisoning from which the gut doesn’t quite recover
Poor diet
Antibiotics
Parasites
Food sensitivities
Our mental state (yes, it's bi-directional),
And this can impact you in a number of ways.
You might get: chronic indigestion, constipation, diarrhoea (or the joy of having both), gut pain, bloating, general discomfort…
You may even go to your GP and receive a diagnosis of IBS…
And you may start to notice a change in your mood.
Mental Health and Gut Health
People with IBS are more likely to get diagnosed with depression or other mental health issues. And people with mental health issues have higher rates of IBS.
And unfortunately, IBS and mood issues can become a “vicious cycle” where each one worsens the other.
What is SIBO?
S.I.B.O is one of the common issues I come across when working with people with mental health issues. S.I.B.O stands for Small Intestinal Bacterial Overgrowth.
S.I.B.O is when the bacteria in the large bowel (large intestine) translocated to the small bowel (small intestine).
Where it shouldn’t be.
S.I.B.O can be caused by:
low gastric acid (related to nutrient deficiency, stress or medications)
acid blocking medications (PPI's) such as Omeprazole and Ranitidine
Stress
Constipation
A diet low in Omega Three fatty acids
Normal distribution of bacterial versus SIBO
S.I.B.O can be diagnosed with a breath test, but there are a few tell-tale signs that you might have S.I.B.O:
These are:
bloating shortly after eating which causes discomfort
constipation and or diarrhoea
Difficulty digesting certain starches and carbohydrates such as:
Resistant starches (which are great for our gut and microbiota!)
Foods such as lentils, chickpeas, green bananas.
And foods which contain inulin - such as garlic, onions and leeks.
Did you used to tolerate these foods and now can't?
Various things can help to treat S.I.B.O including certain probiotics, supplements and lifestyle measures.
The Perfect storm for Gut issues to arise
You may have been someone that never had issues with your gut (or perhaps mild) - but over time began to develop gut issues. A sequence of events can create a ‘perfect storm’ for gut issues to arise - and it often looks a little like this:
You had an illness or acne and you were placed on a few doses of antibiotics.
You may have had a poor diet, went vegan for a few years (and didn’t do it well) or had an episode of food poisoning.
You then experienced a period of significant stress (cortisol - the stress hormone can create impaired gut-barrier function, as well as a reduction in digestive acid).
Your gut starts to play up - you may or may not get an IBS diagnosis.
Then you notice that your mood isn’t that great. Anxiety, depression, irritability, low energy. And often the GP may believe you are depressed and suggest anti-depressants.
I've certainly seen it a number of times. (This is when people often come to see me!)
Now this doesn't happen with everybody and many people can have all sorts of things and not suffer any gut issues, or people may have gut issues and no mental health issues. Others seem to be slammed by everything that comes their way.
Did you know that it can take up to two years for the microbiome to recover the bacteria lost following some antibiotics?
What does the gut have to do with mental health?
The microbes in your gut (large bowel) are not just bacteria laying around doing nothing. They send messages to each other about the state of the gut, help metabolism (and therefore you to absorb) nutrients (especially B vitamins), and defend against pathogens (bad bugs!).
(See more on neurotransmitters and their impact on mental health here and how diet impacts mental health here)
A healthy gut microbiome is essential for serotonin (and other neurotransmitter) production. Your immune system function relies on having a healthy microbiome and a healthy microbiome promotes a healthy barrier between your gut and your bloodstream, preventing things such as endotoxins from entering into your blood. An unhealthy gut can contribute to systemic inflammation - which has a relationship with mental health issues.
WHAT CAN YOU DO?
If you struggle with:
- heartburn
- stomach pains, bloating or cramps
- constipation (moving less than daily and or hard poops)
- diarrhoea
- unsettled, acidy or grippy stomach
- poor appetite
- difficulty digesting fats
- have undigested food in your stool (poop)
These are all signs that your gut may not be functioning well.
There is a lot we can do to support our gut health and doing these things may improve how you feel mentally.
One thing that is often recommended is a FODMAP diet.
Although FODMAP can help with the symptoms, it rarely addresses the underlying problem.
And, despite how it may feel - food is not usually the problem!
Eliminating certain foods (gluten and dairy are often big offenders), reducing our stress, adding pre and pro-biotic foods, and improving digestion (through supplementing or even simply chewing our food well!) can all make a huge difference.
Some small steps
Here are some easy things you can do for yourself:
Start a Food Mood Poo’d diary (download this free here) and notice the correlation between food, gut symptoms and mood.
Slow down and chew your food well (your stomach does not have teeth!)
Practice a regular relaxation technique and do this before eating (simple deep belly breathing for example)
Support the good bacteria in your gut by adding fermented foods
Have a four-hour break between eating to support gut function (specifically the migrating motor complex)
Increase coloured fruit, vegetables and high-fibre foods which help to feed the microbiome
Have a wide and varied diet
Cut out alcohol and artificial sweeteners and other ‘non-food’ ingredients
Add a bit of lemon juice or apple cider vinegar pre-meals to improve gut acidity
Some supplements may help - including probiotics and herbal ‘anti-microbials’. There has been some research done on the product Iberogast - although this appears to be difficult to access in New Zealand. Ask your local health food store what else might help!
Ideally, however see a health professional who has had some experience in dealing with gut health issues.
Most importantly - understand the relationship between gut health and mental health - sometimes your mental health isn’t in your head!!
Getting help for gut & mental health
If you think you would benefit from a holistic approach to mental health and your gut issues - please get in touch here.
Helen is a registered nurse & life coach, specialising in mental health from a holistic perspective. She is passionate about supporting people to have optimal mental health and well-being.
Based in New Zealand, Helen is available for speaking, education sessions and one-on-one appointments.
Helen Duyvestyn RcN, MHSc
Holistic Mental Health
References:
Bested, A.C., Logan, A.C. & Selhub, E.M. Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part II – contemporary contextual research. Gut Pathog 5, 3 (2013). https://doi.org/10.1186/1757-4749-5-3
Lin HC. Small Intestinal Bacterial Overgrowth: A Framework for Understanding Irritable Bowel Syndrome. JAMA. 2004;292(7):852–858. doi:10.1001/jama.292.7.852