Published: November 13, 2020
The COVID-19 pandemic has highlighted the urgency of our mental health crisis, but mental and emotional wellness is far from a new public health issue. As we look for solutions across treatment modalities, could an untapped area of promise be the healing potential of our bodies themselves: the gut microbiome?
THE RISE OF THE MENTAL HEALTH CRISIS
Depression affects more than 264 million people globally, and according to the World Health Organization, the burden of mental health conditions is rising. There has been a 13% increase in mental health conditions and substance use disorders in the last decade (to 2017). According to the WHO, around 20% of children and adolescents worldwide have a mental health condition, and suicide is the second leading cause of death among 15-29-year-olds. Approximately one in five people in post-conflict settings have a mental health condition.
The impact of a mental health condition isn’t limited just to the person afflicted. Those impacts often carry through to school and work performance, relationships with family and friends, and ability to participate in the community. Two of the most common mental health conditions, depression and anxiety, cost the global economy $1 trillion each year. However, less than 2% of the global median of government health expenditure goes to mental health.
This is truly a challenge for our global community.
And now more than ever, our global community is turning its attention to these issues, exacerbated by the stress and isolation that have accompanied the COVID-19 pandemic. The pandemic has also disrupted or halted critical mental health services in a whopping 93% of countries worldwide, according to a WHO survey published on October 5, 2020.
Our standard slate of mental health treatments, among them therapy, mindfulness, and pharmaceuticals, have immense healing power. But more and more evidence shows that there is a missing piece to the mental health conversation.
THE PROMISE OF NUTRITIONAL PSYCHIATRY
The growing field of nutritional psychiatry seeks to address exactly that missing piece.
In February 2019, the American Society for Microbiology published a piece titled “Of Microbes and Mental Health: Eating for Mental Wellness”. In it, author Christy Harrison, Ph.D., discusses data that suggests a repeated link between diet quality, gut microbiota, and susceptibility to a variety of mental health ailments, independent from other risk factors. Dr. Harrison wrote, “The nascent field of nutritional psychiatry acknowledges the sizable gap between our current treatments for mental health conditions and offers a hopeful other way: adjusting our diet.”
As Dr. Harrison explains, “This does not suggest that pharmaceutical or psychological interventions should be abandoned. Quite the opposite: mental health is multifactorial, and often requires multimodal therapy. The emergence of adjusting diet as a preventative strategy or possible intervention for depression, anxiety or other mental health disorders should not replace standard therapies.”
“Although our brain creates our emotional and intellectual experience, it can be helpful to remember that it is also an organ with needs for nourishment and care, just like our heart or our liver. The brain, too, is sensitive to its environment.” – Dr. Christy Harrison, Ph.D.
Researchers are seeing that mental health disorders share an underlying cause with conditions such as heart disease and diabetes. That cause, systemic inflammation, is key to understanding how mental and physical health connect.
Nutritional psychiatry has also been an area of increased focus for the Harvard Medical School in recent years, as research continues to demonstrate the relationship between nutrition and mental health.
WHAT’S HAPPENING IN THE MICROBIOME?
The microbiome is a community of diverse bacteria that make up the human organism and the gut environment. The cost of microbiota analyses has gone down recently, and as a result, the number of investigations into the gut-microbiota-brain axis has escalated, according to Science Direct in a June 2020 review on research advances in the neurobiology field.
“It makes sense,” writes Eva Selhub, M.D. in the 2015 Harvard Health Blog post titled “Nutritional psychiatry: Your brain on food”. “If your brain is deprived of good-quality nutrition, or if free radicals or damaging inflammatory cells are circulating within the brain’s enclosed space, further contributing to brain tissue injury, consequences are to be expected. What’s interesting is that for many years, the medical field did not fully acknowledge the connection between mood and food.”
It’s becoming clear that we ignore the gut-brain connection at our peril—for example, 90% of serotonin receptors are located in the gut. Uma Naidoo, M.D. shared some of these impacts in a 2018 article in another Harvard Health Blog post titled “Gut feelings: How food affects your mood”. Dr. Naidoo writes, “When someone is prescribed an antidepressant such as a selective serotonin reuptake inhibitor (SSRI), the most common side effects are gut-related, and many people temporarily experience nausea, diarrhea, or gastrointestinal problems. There is anatomical and physiologic two-way communication between the gut and brain via the vagus nerve. The gut-brain axis offers us a greater understanding of the connection between diet and disease, including depression and anxiety.”
Diseases can occur when the microbiome becomes unbalanced, including inflammatory bowel disease (IBD), asthma, obesity, metabolic syndrome, diabetes, and cognitive and mood problems.
We’ve also seen how incorporating different foods in your diet can support your mental health and immunity during the pandemic. In an April 2020 article titled “Eating during COVID-19: Improve your mood and lower stress”, Dr. Naidoo shares that “you might be surprised to learn that certain nutrients in foods have been shown to reduce anxiety or spur the release of neurotransmitters such as serotonin and dopamine — and we all want to feel as good as we can during these times of uncertainty.”
“People are feeling a lot of stress right now, and the unfortunate reality is that stress worsens feelings of low mood or angst, and it also suppresses our immune systems. Therefore, targeting immune-boosting foods will have a dual effect — you may feel less anxious and boost your immunity.” – Dr. Uma Naidoo, MD
Research shows that diet and depression are linked more closely than we previously thought. A June 2019 review from The National Center for Biotechnology Information titled “Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies” aligned with this finding. In their assessment of recent studies between diet and depression, they found that a lower Dietary Inflammatory Index was associated with lower depression incidence in four longitudinal studies.
WHERE WE GO FROM HERE
Now more than ever, it’s important to assess how to support and improve mental health for ourselves and others. Medical professionals and researchers are finding that nutrition and gut health can have a significant impact on our mental health. This often-overlooked relationship between mental health and the microbiome can help bridge the gap in supporting mental and physical health.
This is an opportunity for mental health professionals to more holistically treat conditions like anxiety and depression by applying the core Functional Medicine principle that food is medicine.
Do you want to improve your own understanding of the impact of nutrition, and expand your skill set in how to communicate and support healthy lifestyle changes? Click here to learn more about FMCA’s Health Coach Certification Program.
“Mental Health.” World Health Organization, 2020, www.who.int/health-topics/mental-health.
“COVID-19 Disrupting Mental Health Services in Most Countries, WHO Survey.” World Health Organization, 5 Oct. 2020, www.who.int/news/item/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey.
“Mental Health and COVID-19.” World Health Organization, 2020, www.who.int/teams/mental-health-and-substance-use/covid-19.
Harrison, Christy. “Of Microbes and Mental Health: Eating for Mental Wellness.” American Society for Microbiology, 14 Feb. 2020, asm.org/Articles/2020/February/Of-Microbes-and-Mental-Health-Eating-for-Mental-We.
Pennisi, Elizabeth. “Evidence Mounts That Gut Bacteria Can Influence Mood, Prevent Depression.” Science Magazine, 4 Feb. 2019, www.sciencemag.org/news/2019/02/evidence-mounts-gut-bacteria-can-influence-mood-prevent-depression.
Naidoo, Uma. “Gut Feelings: How Food Affects Your Mood.” Harvard Health Blog, 27 Mar. 2019, www.health.harvard.edu/blog/gut-feelings-how-food-affects-your-mood-2018120715548.
Naidoo, Uma. “Eating during COVID-19: Improve Your Mood and Lower Stress.” Harvard Health Blog, 7 Apr. 2020, www.health.harvard.edu/blog/eating-during-covid-19-improve-your-mood-and-lower-stress-2020040719409.
Selhub, Eva. “Nutritional Psychiatry: Your Brain on Food.” Harvard Health Blog, 16 Nov. 2015, www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626.
Järbrink-Sehgal, Ellionore, and Anna Andreasson. “The Gut Microbiota and Mental Health in Adults.” Current Opinion in Neurobiology, Elsevier Current Trends, 9 Mar. 2020, www.sciencedirect.com/science/article/pii/S0959438820300362.
Lassale, Camille et al. “Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies.” Molecular psychiatry vol. 24,7 (2019): 965-986. doi:10.1038/s41380-018-0237-8, 26 Sept. 2018. https://pubmed.ncbi.nlm.nih.gov/30254236/.