The Impact of Gut Health For Mental Health and Relapse Prevention

Foreign. I'd like to welcome everybody, today's presentation of the impact of the gut health on relapse prevention. I'm your host, Dr. Donnelly Snipes. Disclaimer. Got to put out there. This is for educational purposes only and not intended to replace medical advice. Obviously, we are not prescribers. We are not going to tell people how to modify their gut microbiome. But it's important to be aware of the fact that our gut microbiome does potentially impact people's ability to experience the full benefits of recovery. We're going to briefly review the findings from the research identifying the connection between the brain and the gut. When I say briefly, I mean as brief as I could get it because there is a ton of literature out there on pubmed about the gut brain axis. We're going to differentiate gut health from proper nutrition, identify signs and consequences of poor gut health, explore the bidirectional relationship between the brain and the gut, which is also called the second brain, and identify promising alternative approaches to treating mood and other disorders. So let's start at the beginning. Intestinal microorganisms interact with the neuroendocrine system to modify behaviors relevant to stress, eating, obesity, sex, social behavior, cognition, addiction and inflammation. So these intestinal microorganisms are really very vital to what's going on. If you want to think of your body like a factory, I. I often use that metaphor. Think of the intestinal microorganisms as the. Some of the line. The line workers, the floor workers that are trying to make the stuff to get things done. Your intestinal microorganisms help make your hormones and your neurotransmitters and other things like that. So if you know a whole group of them is calling in sick, so to speak. If, if your intestinal microorganisms aren't all present and accounted for in the balance you need them to be, then the factory might not operate as efficiently as possible. Depression is the leading cause of disability in the world according to the World Health Organization. And unfortunately, the effectiveness of the available antidepressant therapies is limited. And one reason for this, I want you to think about antidepressants and depression and however, think of it like a leak or like water pressure. You're in your house and you turn on the water, you're getting ready to take a shower and you notice there is no water pressure. Well, you can turn up the water pressure, which is akin to taking antidepressants to increase the amount of serotonin. And that may help for a little while. But unless you identify why your water pressure suddenly, you know, disappeared, you're probably not going to solve the problem. And wherever that leak is that is preventing the water pressure from being what it's supposed to be is probably only going to get worse. Leak or blockage or whatever it is. Same thing is true when it comes to depression. A lot of times we need to look and say, okay, why are this, is this person's neurotransmitter balance out of whack, and it may not be serotonin. Remember, when we talk about depression, for example, it could be norepinephrine, it could be dopamine, it could be serotonin, it even could be an excess of acetylcholine. So there are a lot of different permutations of neurotransmitter imbalances that can contribute to depressive symptom symptomatology. Which is why a lot of times antidepressants aren't wholly effective. Because, you know, antidepressants typically work on serotonin. And if the cause of the depressive symptoms is not a serotonin deficiency, well, that could be a problem. It could also be a, a problem in the serotonin system for further down the line where the body's producing plenty of serotonin, but it's not getting transmitted. So we, my point is we're starting to recognize that antidepressants really only help about 30% of the population. And even for them, a lot of times it's not. What we're doing is putting a band aid on it. We're going out to the street and turning up the water pressure artificially. And we're not addressing the cause of the low water pressure. We're just kind of doing a workaround. Data from the literature suggests that some subtypes of depression may be associated with chronic low grade inflammation. And we've talked about that multiple times. There are a lot of, there's a lot of information showing a direct correlation between increases in inflammation and increases in depressive symptoms, which kind of makes sense. I, I mean, when you've got inflammation, you tend to be in pain, your HPA axis is hyperactivated, you're not going to be sleeping well. When you're not sleeping well, your brain, your thoughts get foggy, adenosine builds up, you know, and you can see how you can easily start evidencing symptoms of depression, apathy, difficulty concentrating, a sense of low energy, fatigue, you know, all that stuff, stuff uncovering the role of the intestinal microbiota in the development of the immune system and its bi directional communication with the brain have led to growing interest on reciprocal interactions between inflammation, microbiota and depression, as well as other things. Now. And we'll talk about that in a minute. Gut. Gut microbiota appear to influence the development of emotional behavior. When our gut microbiome is not adequate, it's not going to, as I said earlier, it's not going to necessarily be able to produce the neurotransmitters and the hormones that we need in order to have everything in. In balance the way we need it to be. 90% of your serotonin is made in your gut, and a lot of your other neurotransmitters, you'll learn, are also made in your gut. So gut microbiota influence emotional behavior, stress and pain modulation, and brain neurotransmitter systems. Sorry. Now remember that serotonin, among other things, is, and dopamine are both involved in stress management and pain perception. So if those neurotransmitters are out of balance among others, it can contribute to problems in all of these systems. Microbiotic changes caused by illness. You know how when you get the flu or something, your stomach gets upset and, or you take antibiotics and it just wipes out everything that's going to alter your body's ability to effectively produce the neurotransmitters and hormones it needs. Dietary changes can also affect the microbiota. What you eat feeds those little workers. And if you suddenly change something, you know, you change the menu, you may have some picky eaters down there that aren't getting what they need, so they may start to weaken or die off. So dietary changes are important to recognize how they impact a person. People with Crohn's disease, for example, if they eat gluten, it's going to have a significant impact on their gut health and, you know, pain and everything else. Probiotics and antibiotics impact the endocrine and neuroendocrine system. Probiotics obviously increase the bacteria, but just like anything else in your, in your body, in your brain, whatever, it's all in balance. So if you add a whole bunch of Lactobacillus, which is one of the bacteria that's in yogurt, well, that's great, but that's only one of like 100,000 different species that your gut needs. And by doing that, you may be overpopulating one type of bacteria. So it is important to not go hog wild. You actually can eat too much yogurt. You can eat, take Too many probiotics and actually throw your system out of whack through an overpopulation. Antibiotics tend to go in and they're not selective. You can have gram positive and gram gram negative or broad spectrum, but either way you're wiping out whole colonies of bacteria that are actually needed to a certain extent or may be needed to a certain extent in your gut. So when you're taking antibiotic for an ear infection, for example, you know, you're upsetting the, the apple cart in the gut in order to enhance or to get rid of the bacteria in your ear infection, which, you know, it's kind of interesting how the body works, but it's also important to recognize that, you know, it's important to rebuild that microbiome if you have to take antibiotics because it does impact the endocrine system. The brain can alter microbial composition and behavior so via the autonomic nervous system. And that's top down. When the brain experiences stress or distress, what happens to our gut? Things start moving faster. That HPA axis kicks off. It's not time to rest and digest. The microbial composition is going to change. So the microbes that can help support the fight or flee response can support the stress response. They go into overdrive. And the other ones are kind of pushed aside if you kind of want to. That's grossly oversimplified, but you can think about it that way. We know when we get stress, it impacts our gut. But what we probably didn't realize that it's not just that it gives us a tummy ache, it's not just that, you know, we have a difficulty eating. It actually disrupts the workers that make the hormones and neurotransmitters that can help us feel relaxed, feel calm, get good sleep, keep our immune system strong, etc. Even mild stress, we're not talking about traumatic stress, even mild stress. Chronic stress can change the microbial balance in the gut, making the host more vulnerable to infectious disease and triggering a cascade of molecular reactions that fuse feedback to the central nervous system. Now when we're talking about people with anxiety, depression, addiction, and to a certain extent, you know, some of your other things like schizophrenia, but generally they've mainly studied anxiety, depression, addiction and adhd. Mild stress can change the microbial balance. When people start feeling distress, then it can, because of a neurochemical imbalance, it can make it harder to deal with stress from a neurochemical standpoint. Then the cognitions jump in there. Remember your cognitive behavioral triad. You know, the cognitions jump in There when their affect is already low, and then their behaviors may follow along. So once that cascade starts, you can start to see a relapse in, in thoughts and behaviors. Exposure to chronic stress decreased the relative abundance of bacteriocides species and increased the clostridium species in the cecum, which also caused activation or inflammation in. In the body activation of the immune system. So when we are under chronic stress, and we've talked about this before with disregulation of the HPA axis, initially the HPA axis sends out cortisol, which is a steroid, and it suppresses inflammation for that acute fight or flea. But if that acute situation becomes chronic, then we actually the. The body becomes insensitive or it ignores basically the cortisol, it ignores the steroid, and inflammation happens instead. So the, the, the cortisol basically loses its effectiveness to suppress the inflammation. As that inflammation goes up, we see increased depressive symptoms. Children with autism spectrum disorder treated with oral vancomycin, which, which is an antibiotic to reduce cholest cholestritum. Cholestridium, sorry. Had significant improvement in behavioral, cognitive and GI symptoms. Now go back to that disclaimer. I'm not saying that every child with ASD should undertake this, but it is interesting to note that an overgrowth of this particular type of bacteria in the gut does contribute to behavioral, cognitive and GI symptoms in some children with ASDs. Alcohol abuse impacts the gut microbiome. We know when people drink alcohol, it's inflammatory. And it also, you know, because the alcohol is pretty potent, it can kill off certain bacteria that are in the gut. So alcohol abuse impacts the gut microbiome, which results in nutritional deficiencies. When there's inflammation, when some of those bacteria are killed off, when the system is not working like it's supposed to, then it can't break down the food and absorb the nutrients like it needs to. So, you know, if you want to, you keep with the factory metaphor, think about the, the line workers, when they're exposed to alcohol, you know, they're all too drunk to do their job. Probiotics increase the intestinal levels of potentially beneficial bacteria, which in people with alcohol abuse, improved liver functioning, which is involved in digestion, and demonstrated beneficial psychotropic effects on anxiety and depression. People who are in recovery, well, people with alcohol abuse issues and people who are in recovery from alcohol abuse issues often have some concurrent anxiety and depressive symptoms. And we're starting to realize that, yes, some of those may be due to, you know, recognizing what they're recovering from. And recognizing some of the things they did or are doing in their addiction. But some of it also may be due to a neurochemical imbalance that is caused from a biochemical standpoint. The alcohol actually caused a dysfunction in the gut microbiome. Changes in the gut microbiome and its metabolites may not only be a consequence of substance use, but it also may play a role in mediating behavioral responses to drugs of abuse. So we're not just talking about alcohol, we're also talking about marijuana, cocaine, opioids, etc. All of those things. Anything we ingest goes down to feed the workers. And if we are not feeding the workers properly, then it's going to affect the health of the of the colony. Acute and chronic stress increase gastrointestinal and blood brain barrier permeability through the activation of mast cells. So when people have acute and chronic stress, we know that it alters the gut microbiome, but it also makes their gut more permeable. So some of the toxins that are formed, you know, you don't want stuff leaking out of your gut. Some of the toxins that are formed in the gut actually are able to leak out and which contributes to inflammation in the throughout the body. And that some of those toxins can also make their way through the blood brain barrier, which contributes again to more inflammation. Inflammation of the GI tract places stress on the microbiome through the release of inflammatory cytokines and neurotransmitters. So inflammation, we know, causes the release of upregulation of the immune system. You know, the body doesn't like inflammation. It wants to fix it, but a lot of times to fix it, it has to cause inflammation. So it's this interesting little balance coupled with the increase in intestinal permeability. These molecules then travel systemically. So when the GI tract is inflamed, is bothered because of stress. And it could be physiological stress, like somebody with Crohn's eating gluten, or psychological stress. When that happens, more cytokines are released. The HPA axis is activated, the gut becomes more permeable. Then the these toxins, these molecules start traveling systemically and the immune system goes, hey, y' all aren't supposed to be out here. And then we start seeing some systemic inflammation as the immune system chases these toxins. Think pac man. Elevated blood levels of cytokines TNF alpha and MCP increase the permeability of the blood brain barrier, enhancing the effects of rogue molecules for from the permeable gut. Their release influences brain function. Which has been associated with increases in anxiety, depression, and memory loss. Now, where. Whereas I've said repeatedly that there is no easy way to test for neurotransmitter levels in the brain, you can't identify neurotransmitter, neurotransmitter levels throughout the body with a blood test. And it's very easy to identify the levels of your inflammatory cytokines through a blood test. So it is. They are able to track a lot of this stuff pretty closely, even in humans. We're not just extrapolating from rats or something. The vagus nerve is one of the biggest nerves, and it connects the gut to the brain, and it sends signals in both directions. In mice, it was found that feeding them a probiotic reduced the amount of cortisol in their blood. So having a healthy gut brain axis or having a healthy gut microbiome reduces stress. When it's healthy, the gut sends the signal to the brain that, hey, all clear here. The workers are doing fine, everything's great, cortisol's reduced. When the brain gets the signal that, you know, some of the workers aren't doing so good, you know, something's amiss in the gut microbiome that triggers that HPA axis that triggers stress, because the brain says, okay, we are not functioning optimally. And so it works. You know, it works both ways. So in, in mice, they did find that give. Giving them a probiotic reduced the cortisol in their blood. However, in these same mice, and we can't do this with humans, when their vagus nerve was cut, the probiotic had no effect. So this just really underscored the importance of the vagus nerve in the communication between the brain and the gut. And it also helped us really realize that our gut does play a big role in our endocrine system. Alterations in the gut microbial community have been implicated in multiple host diseases such as OBEs, obesity, diabetes, and inflammation. And recent evidence suggests a potential role of microbiota gut brain axis in neuropsychiatric disorders such as depression, anxiety, and addiction. Research has found that tweaking the balance of gut bacteria can alter an animal's brain chemistry and lead it to become either more bold, more anxious, or more depressed. And these particular studies were focused specifically on animals because they were needing to assess the brain chemistry. But there has been some observational data that indicates that brain tweaking the balance of gut bacteria in humans has a similar effect. A healthy gut absorbs nutrients sufficiently and efficiently in order to support brain health. Our body takes what we eat breaks down the nutrients and uses them to make serotonin, norepinephrine and your gonadal hormones, your thyroid hormones. You know, we need everything that we eat. And in the right balance, a healthy gut prevents bacteria and inflammation caught and inflammation causing agents from leaking into the bloodstream. We want that gut to be healthy so some of those toxins don't leak out. The healthy gut produces neurotransmitters and actually manufactures about 95% of the body's supply of serotonin. Now we're going to talk about specific bacteria here, just to give you an idea. Lactobacillus and Bifidobacterium synthesize GABA from monosodium glutamate. Now, one of the common popular yogurts on the market that is designed to help reset the gut has both Lactobacillus and Phytobacterium. Now there are lots of different types within these families, but that is those are two types of bacteria that are in our gut and they're needed in order to make gaba, which is our natural Valium, our natural calming hormone. And, but it synthesizes GABA from msg. Who knew, you know, for the longest time I grew up her hearing that MSG in any form, in any amount was bad, but not so much. E. Coli, Bacillus and saccharomyces produce norepinephrine. This is another one. You know, for my entire life I've been told that E. Coli is bad. Well, in overpopulation it is and you know, eating it, not, not good for us. But we do need have a certain amount in our gut and we need to make sure that that colony survives. Candida, Streptococcus and Enterococcus produce serotonin. Now Streptococcus, Enterococcus and Candida we've all heard of as, you know, big bad boogeyman. But again, they're necessary for the product, for the production of serotonin. And Bacillus and Serratia produce dopamine. My point being we need a variety of different bacteria. We need to be aware that our gut is very much more diverse than we originally thought. Danielle asks, what's the difference between all the probiotics on the shelf versus those that are kept refrigerated? And can these healthy probiotics stay active alive on the shelf? The ones on the shelf are freeze dried, so those are, and, and they typically are in the capsules. They will have a particular shelf life just like your, your yogurt and those sorts of Things have a particular shelf life in terms of what to ingest and what actually works and what's good for you. I would always recommend people consult with a registered dietitian because they'll get the best information. There's also remember that dietary supplements are not regulated by the fda. So while it may say it has a hundred thousand live cultures or whatever, that doesn't really mean that that's necessarily what's there. So it's really important to make sure that people are educated about so they don't get taken advantage of by scams or overpriced supplements that are really not very effective. Your dietitians are probably going to be the ones that are most in the know about that mucosal 5ht which is a serotonin, serotonin precursor in the gut. It's mucosal, it's mucus, but has five HT plays a direct role in the regulation of intestinal permeability. Permeability. So if mucosal 5ht is not healthy, if you don't have the nutrients to make it, then it's not going to be available. It's not going to be there to play a role in the regulation of intestinal permeability. Norepinephrine, epinephrine, dopamine and serotonin are able to regulate and control not only blood flow but, but also affect gut motility, nutrient absorption, gastrointestinal immunity, which is where your gut actually regulates the microbiota and the microbiome. Leaky gut, which has been popular in the, over the past five years or so, I think, is when the cells lining your gut aren't stuck together as tightly as they could be, which allows proteins, viruses, bacteria and more to, to leak out of the gastrointestinal tract and into the bloodstream. Leaky gut syndrome is often described as an increase in the permeability of the intestinal mucosa. So that mucosal 5ht, which could allow bacteria, toxic digestive metabolites, bacterial toxins and small molecules to leak into the bloodstream, which we know contribute to the inflammation and can travel up and permeate the blood brain barrier. In some cases. Lipopolysaccharide is an inflammatory toxin made by certain bacteria. TNF alpha is an inflammatory cytokine also made in the gut, which has been linked with depression and a reduction in serotonin production. Inflammation and a high LPS in the blood are, are associated with a number of brain disorders including severe depression, dementia and schizophrenia. I told you schizophrenia was going to Come in here a little bit. These molecules, these inflammatory cytokines, and the lipopolysaccharide increase inflammation, which trigger the HPA axis. When we have inflammation in our body, then the HPA axis registers that as a threat. It says, okay, you're not 100%. That means we're vulnerable. So that HPA axis is triggered, which triggers the fight or flight reaction, so to speak. It triggers the stress reaction. The HPA axis, when it activates the stress reaction, releases cortisol and suppresses serotonin and alters the balance of the sex hormones in order to prepare the body to fight or flee. Given its ill state, when inflammatory agents leak into the bloodstream, it increases the permeability of the blood brain barrier. We talked about that. Letting those potential inflammatory molecules into the brain. Inflammation again is associated with major depressive disorder. Those with major depressive disorder and a recent suicide attempt had higher levels of gut permeability markers than others. So that's really interesting to note that. Remember, we were talking at the very beginning about how not only does the gut microbiome impact mood because it alters the neurotransmitters, but it also can contribute to alterations in behaviors, including the intensity of the depression and the propensity for a suicide attempt, according to this article. So let's look at the gut brain connection really quick because a lot of our autoimmune issues are caused by systemic inflammation. They're worsened by stress. So let's look at some of the crosses and what you'll see are the things that are bolded. Fatigue, sleep issues, difficulty concentrating, GI disturbances, achiness, pain and sugar and carb cravings are common to both mood disorders, autoimmune disorders, and leaky gut. You also have, you know, brain fog and memory loss, which also goes over here with difficulty concentrating. We see a lot of overlap. As the HPA axis is activated, we have less people have less cognitive flexibility. They're not sleeping as well. So adenosine builds up. Concentration, memory become difficult. Fatigue, when you're not sleeping well and when your body is desperately fighting 24, 7 against inflammation can all be associated. We know that when people are under increased stress. So let's start over here. With mood disorders, it can worsen autoimmune issues. And we know, we've already talked about multiple times today how increased stress is also associated with changes in the gut microbiome that contribute to leaky gut or intestinal permeability. As the gut leaks, it contributes to inflammation, which is going to worsen autoimmune conditions, which is going to worsen mood disorders. So all of these are almost, if not completely inextricably intertwined. And it's important that we assess the physiological conditions that may be underscoring the mood issues and the neurotransmitter imbalances in our clients who present with mood disorders or addictive behaviors, or even autism spectrum disorders and adhd. Remembering that even though it's hard to wrap your head around, the gut microbiome affects behavior in addition to mood and health and pain interventions. Psychobiotics, which are live organisms when ingested, may produce health benefits in patients suffering from mood disorders. And, and again, they need to be in the right balance. It needs to be a quality supplement, needs to be checked out with a physician or dietitian. Too many people just, you know, all of a sudden want to jump on Amazon and order the most expensive psychobiotic out there because they think that's suddenly going to replace and make everything all better. And that's just not the case. Remembering that a lot of people with addictive disorders or mood disorders or both have cognitions, you know, associated with what's going on, behaviors associated with their presenting issues, as well as neurochemical imbalances. So we really need a three pronged approach. And psychobiotics may be part of the treatment plan, but it's not likely going to be the only thing. In a study of 124 healthy volunteers, mean age of 61.8 years, those who consumed a mix of specific psychobiotics exhibited less anxiety and depression. Children with ADHD were substantially improved on either an AFC free diet or by dietary supplementations with polyunsaturated fatty acids, iron and zinc. Now those are obviously not psychobiotics, but those are nutrients that go to support the gut microbiome. Nutrition activates hormonal neurotransmitter and signaling pathways in the gut. Even if the person is eating healthfully, if the bacteria are not there to break down the nutrients and make the neurotransmitters, they're going to continue to have mood and behavioral and physical symptoms. In a study of older adults, it was found that healthy nutrition can actually reduce the incidence of depression about 40 to 50%. That's huge. That is absolutely huge. And that is better than what they're finding for the effectiveness of antidepressants. So imagine what would happen if we started using a multi, multimodal approach when people first presented to help them, you know, jump start their recovery and, you know, maybe, maybe considering a short course of antidepressants to get them jump started, but then also adding in nutrition in there to repair the leak or clear the blockage that's preventing the system from working effectively. And you know, so when that gets up and running, then they can wean off, potentially may be able to wean off the psychotropics. Obviously that needs to be combined with cognitive behavioral therapy in people who are already depressed. This study was looking at preventing depression. But if somebody is already depressed, anxious or dealing with addictive issues, we need to help them address that. Because no matter how good their nutrition is, if they're still experiencing chronic stress, it their vagus nerve is going to be getting, sending the signal to the gut that, you know, things are no bueno out in the world and that's going to alter the gut microbiome for the worse. So we need to address chronic stress. We need to address the cognitions and the behaviors as well as the biological components. Healthy foods like olive oil, fish, fruits, vegetables, nuts, legumes, poultry, dairy, and unprocessed meats, which means meats that don't have nitrates, nitrites, hormones or steroids, those are hard to find, like grass fed beef and organic chicken is kind of what we're looking at, have been inversely associated with depression risk. So helping people consume enough omegas in the right balance, remember, omega 3s are great, but we also need omega sixes and omega 9s, but they need to be in the right balance. Fruits and vegetables have a lot of antioxidants which will help scour out those free radicals and reduce inflammation. Obviously they're also filled with the vitamins and minerals we need in order to catalyze those neurotransmitters. Nuts, legumes, poultry, dairy, again provide nutrients in order to support the construction, if you will, of the chemicals, if you want to use that neurotransmitters, hormones, yada yada, that we need in order to be happy and healthy. Magnesium, calcium, iron and zinc are inversely associated with depression, which makes sense because magnesium, calcium, iron and zinc are all necessary to break down 5ht into serotonin. So we need those in order to construct serotonin. And you know, my guess is norepinephrine and some of those others. Chromium leads to a secondary synthesis of serotonin, norepinephrine and melatonin and have been associated with reductions in depression. Most multivitamins contain chromium. People only need trace amounts of chromium. But I've always, always said when we're talking about Recovery. It is so important for people to consider downloading a nutrition app, nutrition diary, in order to track what they're eating and figure out, you know, which nutrients they're getting plenty of and which nutrients they may not be getting enough of. Vitamin C has been found to have an equivalent effect effect on, with on people as amitriptyline, which I thought was kind of interesting. Now vitamin C is water soluble, so you mega dose on vitamin C, you're just going to have expensive urine. But it is interesting to note that people who have a vitamin C deficiency tend to experience depression. Folate, B12 and B6, all of these are B vitamins, combine to enhance cognitive performance and they also reduce the risk of depression, as does vitamin D, calcium and copper. These are all very common nutrients in a good healthy diet. This is not anything that is super, you know, strange out there that you're going to have to go find weird foods. If you eat a reasonably healthy diet, you, you're probably going to be getting these nutrients. Several medications, metformin and gram negative antibiotics, have shown some potential to treat depression in certain patients. We've got to understand again, what is the cause of their depression, what is the neurotransmitter imbalance that exists or what system, you know, norepinephrine, serotonin, what have you, what system is not functioning effectively? So not everybody is going to respond to this. But for those who, but, but there are some who may prebiotics result in lower cortisol levels, cortisol being our stress hormone and that steroid and improved attention to positive stimuli. Well, that's wonderful. A prebiotic is a nutrient that you eat that actually feeds your gut bacteria. So it goes through your stomach and gets down to your gut to feed the bacteria. And lactose and fiber are your most common prebiotics, which is why people do well, especially if they're eating a fair amount of vegetables because vegetables are high in fiber. Lactobacillus acidophilus induced the expression of cannabinoid 2 and mu opioid receptors in the colonic epithelium. Lactobacillus acidophilus is that lactobacillus in yogurt. And the cannabinoid receptors are those receptors that are in our brain that respond to not only cannabis but also our natural endocannabinoids and are strongly tied to, to our mood. And then mu opioid receptors are those receptors that respond to guess what opioids and, and they can affect the motility of the gut. If you have Worked with people who have taken opioids. You know, that typically slows down gut motility. So la Lactobacillus acidophilus can help regulate gut motility, which is one of the reasons people eat yogurt ch to help, you know, their gut if they're feeling not as regular as they want to. Lactobacillus farimus inhibited stress induced visceral hypersensitivity. Now remember I said earlier that Lactobacillus and Bifidobacterium are just two families, if you will, two colonies of bacteria that have multiple different types within them. And there are hundreds of different types of bacteria in your gut. But these particular bacterium they found to in the right balance, be effective at impacting mood or impacting behaviors in certain ways. Lactobacillus helveticus is a type of lactic acid bacteria that's naturally found in the gut. It and naturally found in certain foods like Italian and Swiss cheeses, Parmesan, cheddar. It's found in milk, kefir, buttermilk, and fermented foods like kombucha, kimchi, pickles, olives and sauerkraut. One of the things that a lot of people are missing in their, in the American diet is the fermented foods and that can be. And a lot of us don't use buttermilk anymore. So adding those could be helpful as well as, you know, some of your Italian and Swiss cheeses. Ingestion of Lactobacillus casei, Sherota, Lactobacillus and Belongum reduced anxiety and depressive symptoms and cortisol levels elevated hypoth, hypothalamic pituitary adrenal axis response and depression in certain rats can be reversed by administering a single bacterium which is called Bifidobacterium infantis. Why am I going through all of these? I really just want to point out how sensitive, how delicate our gut microbiota are. If we can just take one of these, you know, colonies and enhance it or wipe it out, how it actually affects mood. And just like, you know, we don't necessarily know which neurotransmitter is completely out of balance in a person's brain, we, we are completely at a loss for knowing which specific bacterium is out of whack in a person's gut because there are so many of them and, and they're just starting to, you know, investigate one at a time. But it's, it's slow going when you're dealing with that many different types. To increase Bifidobacteria. Take probiotics, especially lactobacillus and bifidobacteria, which can be found in that popular yogurt. Eat high fiber foods like apples, artichokes, blueberries, almonds and pistachios, because that'll give you the prebiotics to feed the good bacteria. Other prebiotic foods include onions, garlic, bananas and chicory root. Now, chicory, if you didn't know in France they actually use it as a coffee substitute. It is naturally decaffeinated. So I mean, it just never had any caffeine in it. So if you're looking for a decaf coffee substitute that doesn't have all those nasty chemicals in it that they use to decaffeinate something, you might try chicory root. It has a, a slightly bitter taste, but, you know, once you get used to it, it's actually really good. Eat polyphenols. Those are the chemicals that are in your really richly colored fruits and vegetables. So polyphenols from foods like cocoa, green tea and red wine. Red grapes. Because polyphenols have the antioxidant capacity to wipe out those free radicals, reduce inflammation. When we have reduced inflammation, we have better gut health. Better gut health. The vagus nerve communicates that to the brain and we get the all is well signal. Eat whole grains such as oats and barley because they give the B vitamins as well as fiber. Fermented foods like yogurt and kimchi, and interestingly enough, exercise increases bifidobacteria levels. How does anxiety or depression perpetuate itself via the gut brain axis? Well, basically what we have talked about in today's presentation is the fact that when anxiety or depression are present, it causes stress. Stress is communicated to the gut from the brain and it alters the gut microbiota in order to support the stress response. Unfortunately, when that happens, that means the gut is not as concerned with producing serotonin and gaba and it's making norepinephrine and acetylcholine and other things in order to fuel that fight or flight response. When that happens, when serotonin is not produced effectively efficiently, then that mucosal 5ht tends to get thinner. So stuff is easier able to go through the mucus or lack of mucus, permeate into the bloodstream, cause systemic inflammation, and potentially permeate the blood brain barrier, which increases inflammation, increases HPA axis activation and increases depression. Gut disorders like irritable bowel syndrome or Crohn's disease, both of these are Autoimmune issues increase inflammation. They tend to get worse under stress and, and they, they can also be worsened by eating certain foods and irritating that gut microbiota. When they are worsened, they cause pain. Pain causes the HPA axis to activate, increases inflammation, and the system starts all over again. Autoimmune disorders themselves, because they depression and anxiety can make them worse. But autoimmune disorders can occur, you know, prior to depression and anxiety. But if they cause perpetual systemic inflammation, then they have found again because of the dysregulation of that HPA axis, that they actually start altering the gut microbiome and can actually start causing or contributing to neurotransmitter imbalances and cognitions that can be associated with depression and anxiety. So those neurotransmitter imbalances start happening, they start feeling more pain. They're feel, they're feeling like they're always in pain, can't ever do anything. And that contributes to a sense of hopelessness and helplessness. For example, when we talk about insulin resistance, it's important to recognize that when the cells in your muscles, fat and liver, don't respond well to insulin, it can't easily take up the glucose from your blood. This can eventually lead to higher than normal blood glucose levels or pre diabetes obesity. Too much fat in the abdomen, around the organs, or visceral fat is one of the main symptoms and some people say causes of insulin resistance. Belly fat makes hormones and other substances that contribute to chronic or long lasting inflammation. Here we go again. In the body, risk factors for insulin resistance include obesity, a sedentary lifestyle and sleep issues. So insulin resistance can actually contribute to to alterations in the gut microbiota because it contributes to inflammation, which can again affect mood. So we're going back to the importance of nutrition. Neuroimmune imbalances have been found as potential biomarkers of stress, anxiety, depression, inflammation and leaky gut, which may result in the imbalance between regulatory and pro inflammatory T cells. T cells are some of your immune cells and regulatory T cells are important. When we have too many pro inflammatory cytokines, that can also be a problem. Are there other questions about the relationship between anxiety, depression, addiction and the gut brain axis? I know we covered a whole lot of stuff, but the main takeaway is that it is important to educate our clients about the importance of good nutrition. Not only to provide the body the building blocks it needs to make the hormones and neurotransmitters and repair all the cells and clear out the free radicals that contribute to inflammation, but it's also important to have good nutrition to feed the workers that make all those things in order to support good health. You're you're going to not reap maximal benefits from any sort of treatment for addiction or mood disorders or any sort of mental health issue if your body is not healthy. And obviously the PowerPoint is located in your in the class. You can download that. You can take a look at that. You can I'll have this video up on YouTube in the next day or two so you can review it if it it is something that you're interested in in the PDF in your classroom. All of the hyperlinks take you to articles in PubMed, so if you want to do an even deeper dive on this, then you most certainly can. If you're interested in this, you know, supplemental or complimentary approach to treatment of addictions and and mood disorders. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is@allce.com podcastceus that's allceus.com podcastce to sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allce.com sponsor thank you.