The Importance of Gut Health for Mental Health | A Counselor's Guide

I'd like to welcome everybody to today's presentation on the gut microbiome and mental health— what counselors, and quite honestly everybody, needs to know. I'm your host, Dr. Dawn-Elise Snipes. The gut microbiome is the heart of the body factory. That's where stuff is taken in, your nutrients are taken in and converted to useful products. We've talked about this a lot. It communicates with the brain about the status of the body. But what happens when the gut microbiome gets out of balance, when the heart of the body factory is miscalibrated? Today we are going to briefly review what the gut microbiome is, explore the connection between the microbiome and neurotransmitters, mood symptoms, and identify common symptoms of dysbiosis and what we can do to help people heal their microbiome. A 2024 review in Biological Psychiatry noted that modern populations have fewer gut bacterial species than ever before, and one consequence of this may be reduced stress resilience. And we've seen it. I'm— you just have to look, not even just in clinical populations, but we've seen in people it feels like that there is reduced resilience. And we're going to talk as we go through about the impact of a reduced diversity of gut bacteria. Stress impacts the gut in two ways. Cells in the gut lining produce and release stress-related chemicals directly into the gut. So you've got the The gut lining is picking up signals from the nervous system. Hey, we're under stress, fight or flight. So it actually produces, um, chemicals and releases them into the gut, which starts changing the pH. Your brain also releases stress hormones into your bloodstream, which travel throughout the body, including the walls of the intestines, where they can leak through the intestinal lining into the gut where the bacteria live. This is especially true when stress damages the gut barrier and makes it more permeable. So people who are already stressed and experiencing leaky gut are more likely to have a more significant impact from stress because they're going to get more leakage into the gut. When a system is working, when the threat is over, the message gets to the microbiome through several automatic processes that happen when your parasympathetic nervous system kicks in. So the SNS, the sympathetic nervous system, starts winding down. The parasympathetic nervous system starts taking over and sending different signals. When this happens, stress hormones are no longer secreted and naturally break down. Any of our hormones and neurochemicals in our body eventually break down over time, and like serotonin, for example. When it's released into the synapse, it sits there for a little while, and then enzymes come and break it down. The same thing is true for virtually every hormone and chemical in our body. So eventually it breaks down, it becomes less effective. Additionally, the vagus nerve— we've talked about that before— 80% of its nerve endings are kind of tied to the parasympathetic nervous system. It releases acetylcholine into the gut to reduce inflammation and repair the gut barrier. When we're stressed, especially for a long time, the pH changes and it disrupts the gut barrier. So when the stress goes away, the vagus nerve says, hey, time to clean things up. Acetylcholine comes in, turns down that inflammation, and the gut pH changes back to a proactive, if you want, if you will, uh, pH and digestive enzymes are released again. So everything starts again. Our parasympathetic nervous system is our rest, digest, and repair. When we're in sympathetic nervous system, the fight-or-flight system, we're not digesting, we're not repairing. So any food that's in there isn't really going to get digested, or at least not as well. And I want you to think about times when you've been stressed, and not to get too graphic, but food tends to not get digested as much or as well when it goes through your system. This is because, partly because, the digestive enzymes are not being secreted to the same extent. Chronic or repeated stress, and this is really important for our clinical population Chronic or repeated stress causes stress hormones to stay elevated for days or even weeks after the stressful event. This means the bacteria keep getting stress signals from the body even when the person thinks they've calmed down. So people can downregulate, their heart rate can return to baseline, their breathing can return to baseline, and they can be like, okay, I've triggered my parasympathetic nervous system, we're all good. It takes the gut a while to catch up. Because of this, it starts creating a vicious cycle where the stressed gut, the stressed bacteria, produce chemicals that keep stress hormones high, which keep the bacteria stressed. Which means that for a lot of the people that we work with, because those stress hormones are sort of behind the scenes staying high the perception of stressors tends to be one of either neutral or negative instead of more positive. In the gut microbiome— and we've talked about the gut, we've talked about how it helps break down nutrients, but how important is it really? I mean, we just kind of think of it as our stomach and sometimes our intestines. Inside your— in— inside your gut, the stomach and the intestines, the microbiome produces and modulates serotonin. Our— well, serotonin does everything. It's involved in our heart rate, in our breathing, in our blood pressure, in our mood, in our sleep. It has its grimy little mitts in everything. 95— 90 to 95% of your serotonin is produced in your gut. So if the microbiome is out of whack and not producing it, guess what? You're gonna have a problem. Norepinephrine, which is our focus chemical, and it actually is also released at night to help trigger GABA and melatonin, that's also produced in the gut. If norepinephrine is not, um, being adequately produced, we got a problem. Dopamine, our main motivation chemical. GABA, our main relaxation chemical. Glutamate, our main energy chemical. Oxytocin, our tend and defend hormone. Testosterone and estrogen, two of our main gonadal hormones. And melatonin are all modulated and produced in the gut to a large extent. Now, there are peripheral sites for a lot of these, but the majority of what is going on in the production and modulation of these neurotransmitters takes part in the gut. Cortisol, our main stress hormone— now, I said glutamate is our excitatory hormone, it's kind of like our caffeine or something, Cortisol is our stress hormone, but cortisol is naturally released. We have the awakening response, it's naturally released in the morning and declines during the day. When cortisol is high, serotonin is low, and vice versa. Cortisol released is modulated through the microbiome changes. Our microbiome is on a circadian clock like everything else, so when the night shift is there doing the repairing and recalibrating and everything else that it does, cortisol's low. When the day shift shows up to help us get energy and think and do all the stuff we do during the day, cortisol goes higher. And, and that's because, partly because, we have different microbes in our gut. The thyroid is also in part modulated by the gut bacteria. Gut bacteria produce enzymes that allow thyroid hormones to be absorbed into circulation. There are a lot of causes for non-thyroidal illness syndrome and hypothyroid and other things, but they have found a direct correlation between the microbiome imbalance and particularly hypothyroid. In terms of dysbiosis, what kind of— or an imbalance in the, in the gut microbiome— what types of symptoms might we see? And the reason I'm going over symptoms is because a lot of our, our patients come in and they start complaining about or reporting different symptoms. And circadian disruption can be a part of depression, it can be a part of anxiety, it can be a part of hypothyroid. It can be a part of a lot of things, and it can also be a part of microbiome disruption. Gut bacteria produce chemicals, especially short-chain fatty acids— SCFA is what you often see it abbreviated as— um, so short-chain fatty acids like butyrate and bile acids that send signals to your body clock in order to maintain circadian rhythms. If those gut bacteria are not prevalent enough or not working, then your circadian rhythm may get off. Even if you're trying to go to sleep at the same time every day and you're doing all those good circadian anchoring things, if the gut microbiome is a mess, your brain may— the signaling may not be happening as effectively. If they are reporting sleep disruption— now remember, circadian rhythms regulate everything. When we salivate, when we're hungry, when we go to sleep, when we wake up, our immune system, our gonadal hormones— they regulate everything. So when those things are off, for example, when women report that their menstrual cycles are very irregular one of the things we want to look at is the gut microbiome because it could be indicating circadian disruption. Now there is— well, there are tests that can be done of the fecal matter to try to estimate what's going on in the gut. Ultimately, we are going to identify microbiome disruption as a condition by exclusion. So we're going to look at other things and go, what else is going on here? Most people, most people with depression, depression, anxiety, bipolar, schizophrenia, autism— things that they're going to come to clinic for— most of those people have a disrupted microbiome. Heck, according to that British Journal of Psychiatry, most people, even the non-clinical population, have a disrupted gut microbiome. Therefore, educating and bringing this up is not harmful. It is empowering people to identify strategies they can use to start taking control of their well-being. Sleep disruption. When gut bacteria are out of balance, they stop producing the right chemical signals at the right time, disrupting the body's circadian rhythms and causing sleep problems. Inflammation is another symptom of an imbalanced gut microbiome, or dysbiosis. When our microbiome gets out of balance, we start to see thinning of the mucus that lines the gut, and it— the gut becomes more permeable to toxins and all kinds of stuff we don't want permeating. We see people have to start developing leaky gut, which when the toxins leak out of the gut, you know, you can only think, you know, think about a sewer system and stuff leaking out of the sewer system into your house. Not what you want. When people have leaky gut, the toxins that leak out get into the bloodstream and very easily cross the blood-brain barrier. So we start seeing more systemic inflammation. Healthy gut bacteria produce those short-chain fatty acids, which are anti-inflammatory, when they digest fiber or prebiotics. Now, how many times in other classes have I said our clients need to consider eating a diet that is relatively fiber-rich? Now, that's going to differ for each person. But when we talk about fiber, we're talking about fruits and vegetables. We're not talking about having to eat bran muffins and psyllium husk, although those are wonderful, um, in my opinion. It's not a huge leap for a lot of people to start getting some more fiber. In the American diet, we are horrible, horrible about getting enough fiber in our diet, especially the omnivores out there that like to eat a lot of meat. That is an easy way to start feeding the gut bacteria and strengthening the healthy gut bacteria by giving them that fiber, which is a prebiotic, a, a bacteria food, if you will, which is then converted into an anti-inflammatory. Sweet. We also see when people have inflammation, when they have dysbiosis, they develop inflammation. We see reprogramming of our T killer cells. These are the cells that we want to come in to, um, help manage disease. The short-chain fatty acids and tryptophan metabolites help produce anti-inflammatory, uh, T cells. But when we don't have that coming in, we don't have the short-chain fatty acids, we don't have tryptophan metabolites, then the T cells aren't going to be anti-inflammatory. And we also start to see, when there's inflammation, we start to see lower gut bacterial diversity in people. As inflammation goes up, the brain registers that as a stressor, triggers the stress response. Starts sending those stress hormones into the gut, changes the pH, changes the gut microbiome, and we start seeing inflammation and higher CRP— is C-reactive protein. This is not something we generally want to see high in people. When we have more bacterial diversity in our gut, CRP generally drops some, and that's good. When people complain of fatigue, that can also be caused by dysbiosis. Healthy gut bacteria produce butyrate, a short-chain fatty acid. See how we keep coming back to this fiber byproduct? Um, healthy gut bacteria produce butyrate that is essential fuel for your cells. So not only is it anti-inflammatory in nature, but it fuels the cells to help them do what they need to do. Dysbiosis, um, imbalance of microbes, can shift tryptophan conversion to producing metabolites that cause fatigue and cognitive dysfunction. So one set of microbes will convert tryptophan into something that gives us energy and helps, um, modulate our immune system, and it's a good thing. The other set of immune cells, not so much. It produces toxic metabolites that cause fatigue and cognitive dysfunction. Not really what we want. We also see in people who have fatigue, the microbes that are in their gut are overproducing something called D-lactic acid, which also can accumulate, cause fatigue, brain fog, and weakness. We've talked a lot in other classes about how poor sleep can cause fatigue and brain fog and keep the body from clearing the adenosine out of the brain. That's one cause of fatigue and brain fog. Another cause is a microbiome imbalance from the overproduction of D-lactic acid and tryptophan conversion to the to the toxic byproducts. People who report pain— yep, pain is actually— and nociception, our sense of pain, is actually influenced by our microbiome. Gut bacteria produce chemicals that directly affect, directly affect pain-sensing nerves in your gut and throughout the body. Dysbiosis affects how the brain and spinal cord actually process those pain chemicals. So those little critters in there, the microbes, actually impact how our brain processes sensory signals. The types of pain that have been directly related to dysbiosis in the research include gut pain— yeah, go figure— neuropathic pain, nerve pain, inflammatory-related pain, fibromyalgia, migraine, and regional pain syndrome. People who have any of these issues or diagnoses may have an imbalance in their gut microbiome. That is one target for intervention that they can work with a dietitian, they can work with their physician. We can't prescribe, but they can work with the prescribers, they can work with their medical team in order to try to identify any things that might be causing an imbalance in their microbiome. And I'll tell you, inflammation, which can be caused by stress, by trauma, by lack of sleep— inflammation causes disruption in the microbiome. It causes dysbiosis. As clinicians We can help people improve their gut microbiome by helping them reduce chronic stress, strengthen their parasympathetic nervous system, and, um, yeah, impulsivity is another symptom of dysbiosis. Who knew? Well, we tend to be— when we're stressed, when we're in pain, when we've got inflammation, we tend to be more impulsive. We tend to operate more in the fight or flight and the emotional reasoning point of view. So it makes sense that we see more impulsive behaviors in people who have dysbiosis. Neurodegeneration is something else we see in dysbiosis. Dysbiosis contributes to leaky gut. We already established that, which allows bacterial toxins, especially LPS or lipopolysaccharides, to enter the bloodstream. Inflammatory cytokines— these are inflammatory chemicals— move across the blood-brain barrier and activate the brain's immune system called— and the microglia in the brain's immune system, causing neuroinflammation. So the leaky gut, the junk gets into the system, crosses the blood-brain barrier, the microglia jump into action because they're like, this ain't supposed to be here. And then we start seeing neuroinflammation. Chronic neuroinflammation triggers accumulation of misfolded toxic proteins that kill neurons, but it's site-specific. Interestingly, it's not just everywhere. Where do we see these neurons being killed and these misfolded proteins ending up? The 3 places we really don't want— well, there's a lot of places we don't want them— the hippocampus and the amygdala, 2 areas that are involved in emotional processing, and the prefrontal cortex, the area of involved in executive functioning. We really don't want to see shrinkage in these areas and accumulation of toxic proteins. So again, if you're working with somebody who's got brain fog, cognitive slowing, um, even diagnoses like Parkinson's, dementia, um, or Alzheimer's. Yes, changing the gut microbiome is not going to fix that. However, if the microbiome is out of whack and contributing to this neuroinflammation, contributing to leaky gut, then their condition is likely going to progress more quickly. So we can help mitigate what's going on in their body. Emotional symptoms of dysbiosis: anger and anxiety. Well, guess what? That makes sense. When we've got inflammation, when our gut is out of balance, it's not doing what it's supposed to, it triggers the stress response, which puts us on high alert, which means we are more likely to respond with anger or anxiety or we're likely to respond to most anything as if it's some sort of a threat. Dysbiotic gut bacteria alter vagal signaling, sending stress signals to the amygdala and the hippocampus. So basically, these gut bacteria kind of shut down our parasympathetic nervous system and say, nope, we got stress going on here. Leaky gut triggers inflammatory signaling. Which triggers the stress response. And leaky gut and errant vagal signaling cause sympathetic dominance. So when you've got this leaky gut, which doesn't just happen for an hour and then go away— this is something that is a chronic condition for a lot of people, especially if they've had chronic stress— then they've also got errant vagal signaling. So their brain is perceiving things things in the environment as a threat when maybe they're, they're neutral. This causes us to stay in sympathetic activation, stay in fight or flight. So the sympathetic nervous system becomes dominant and the parasympathetic nervous system becomes muted. What happens to people's emotions when we see that? We oftentimes have people who are very, very anxious and/or go into that state of flat to furious and dysregulate. They may just barely be getting along most of the day, but when they're— when they're triggered, oh boy, are they triggered. Dysbiosis also disrupts the brain's dopaminergic system and its ability to assign value to rewarding activities. So when we've got dysbiosis, things that normally would make us happy? And not so much. It's just blah. It's all kind of gray. This is something we hear a lot in early recovery from addiction, for example, because their dopaminergic system just isn't working very well. And for most of them, their microbiome's out of whack. Their brain is having difficulty assigning positive value to rewarding activities. Things that normally would be rewarding just don't kind of make it. One of the things we can do in early recovery for anybody— anxiety, depression, whatever— educate them about the microbiome. The microbiota is necessary for the— your amygdala development. People who are born to parents who— to mothers whose microbiome is out of whack typically end up with a microbiome that's out of whack. That's one thing. We can educate pregnant women about the importance of trying to have a healthy microbiome for the health and mental health of their fetus. When the baby's born, and children who maintain an unhealthy microbiome because they're stressed, they're not getting adequate nutrition, whatever the cause is their amygdala doesn't develop appropriately. That's a big problem because amygdala is where we do our fear extinction and fear processing. And if the amygdala doesn't work very well, we see people end up growing up developing symptoms of emotional dysregulation, um, anxiety, depression, etc. When the gut bacteria are disrupted in adults, even if they were born and, and their gut bacteria was great as a kid, if their gut microbiome gets disrupted as an adult, they lose the ability to modulate effectively their behavioral and emotional responses. This is that impulsivity and dysregulation that, that we've been talking about. Antibiotics. I know for me, when I was a little kid, they loved handing out antibiotics back in the '70s. Um, so I was on antibiotics a lot for ear infections, and they found that the changes in your microbiome persist for years after you finish a course of antibiotics. Some are better than others, But assuming that your microbiome is back 100% healthy again the day after you stop taking in— taking an antibiotic, not so much. And since the composition of the microbiome has so much to do with our mood and our behavior and our circadian rhythms and our sleep, you know, it's something we want to consider. If you have to take an antibiotic, you know, you have to. What can you do when you're finished in order to best heal that microbiome? And that's a question for a medical doctor. I'm not telling you what to do, uh, or how to fix it, but that is certainly something we want to empower people to work on. Cognitive symptoms of dysbiosis include negative cognitive processing bias. And I've already touched on that a few times today, where people's perception of and response to negative stimuli differ depending on the gut microbiota profile. When you've got the healthy microbiome, people's perception of and response to negative stimuli tend to be more resilient. They view it as a challenge. It's not something that's overwhelming. When their microbiome is unhealthy, they tend to view negative stimuli as overwhelming, huge threats. It triggers that stress response and sometimes dysregulation. We also see attention and concentration are negatively impacted when the microbiome's out of whack. Out of whack. The gut bacteria directly produce attention neurotransmitters specifically dopamine and norepinephrine. When those are out of balance, people have difficulty with attention and concentration. When our gut microbiome is out of balance and we've got inflammation and we're in sympathetic— we've activated our sympathetic nervous system, we also know that— I know this is an indirect effect, but we know that when we are in stressed state, our body is borrowing blood glucose for the, for the fight or flight. It's not focusing, it's not feeding, if you will, the prefrontal cortex where we can do our higher-order reasoning. So people with chronic inflammation and disruption have more difficulty with attention and concentration. Cognitive slowing. Now, this can be due to age. It can be due, you know, after you've had an illness or something, you've still got some systemic inflammation going on. You may feel brain fog. Cognitive slowing happens for a lot of reasons. It's not necessarily pathological dementia. Oligodendrocytes produce myelin to insulate nerve fibers and allow signals to travel effectively and quickly, but throughout the nervous system, oligodendrogenesis and myelination are modulated by the gut microbiome. So when we don't have sufficient oligodendrocytes and our oligodendrogenesis is muted, then those nerves are not staying effectively myelinated. And it impairs our nerve— the communication in our nervous system. We also see impaired lymphatic or waste clearance causing a buildup of toxins and inflammation in people who have cognitive slowing. And again, inadequate bacteria to produce short-chain fatty acids for brain fuel. That prefrontal cortex is just starving. The nice thing— our prefrontal cortex, it really likes glucose, but it can function on short-chain fatty acids and even some moderate-chain fatty acids. But we need to have the bacteria in order to prepare that fuel for the cells to uptake. Environmentally, we see increased sensory sensitivity and reduced sensory gating. Lights seem brighter, sounds seem louder. We talked about misophonia last week, I think. Sounds that annoy us sound even more annoying when we've got dysbiosis. Additionally, we have reduced sensory gating. Our brain, because it's in fight or flight, is more attentive to everything, looking for any clue that there might be a threat. So we're not gating out all of those ancillary stimuli, and that's exhausting. It really is exhausting. But bacterial metabolites directly regulate the excitability of sensory neurons. When you've got stress metabolites, those sensory neurons are wide open. When you've got the parasympathetic metabolites, if you will, the sensory neurons are less active, they're less sensitive, if you will, so it doesn't feel as overwhelming in loud places, bright places, etc. Dysbiosis reduces gut bacteria that produce GABA, our main relaxation chemical. We need GABA to relax. We need GABA to help us go to sleep at night. When we don't have enough GABA, we start seeing problems in mood and behavior, pain. GABA is also the main neurotransmitter, interestingly enough, responsible for sensory filtering. People who have difficulty filtering out extraneous stimuli often have low levels of neurotransmitters, or often have lower, lower levels of GABA, which could be caused by dysbiosis. It could be caused by a variety of other things too, but chances are pretty good that at least part of the reason that their GABA is low is their gut microbiome. Dysbiosis also causes functional, morphological, and molecular molecular alterations in the cochlea. That's part of our ear. So noise sounds louder when we have dysbiosis. People are more sensitive to smell. There's, interestingly enough, neurons and a chemical process that takes place in our nose that helps clear out smells. After you smell something, your brain actually goes in and kind of sweeps it away. But people who have dysbiosis, that doesn't happen. So smells tend to linger in their nose longer. Sight and tactile. And the little one next to tactile is just because there was a second article that I really loved, so I wanted to make sure it was in the presentation. But our skin, our nerve endings become more sensitive. And I did talk about this in the physical under pain, But it's important to recognize— I know when I get sick, for example, there are some times that it just, it hurts to touch my skin at all. Um, and we may have clients who report, you know, sometimes I can wear this, this sweater, and other times it just feels like I'm wearing sandpaper. Okay, it could be due to a change in their microbiome. Now, that's not going to make them feel better right away, but helping them recognize that it's not all in their head. There are potential physiological reasons for this. Now what do we do? We're going to look at the causes and interventions together just because it makes sense. I know you're going to roll your eyes. Poor sleep causes dysbiosis. Poor sleep causes stress. Stress triggers all those stress hormones to seep into the gut, change the pH, activate all the stress microbes. Poor sleep is going to cause dysbiosis. This is something we can work with our clients on, helping them understand all the reasons that sleep can actually help them take charge of their well-being. Circadian disruption. The intestinal clock directly drives which bacteria thrive and when. When you eat, when you sleep, and when you wake up at regular times, the gut bacteria follow a healthy rhythm. We're looking at more than just, um, sleep now. For circadian rhythms, we have the, the mnemonic SLEEP. I'm sorry, least. Light needs to be bright during the day and dim at night. Eating needs to be, be done at regular times throughout the day to anchor their circadian rhythms. Activities— keeping a routine can be really helpful. Stress— trying to reduce stress or avoid stress 2 hours before bed can be really helpful to setting those circadian rhythms so your body knows, okay, we stress out from 8 to 5, but then these other times we can relax. And then temperature needs to be cool to help people sleep, and that helps set that circadian clock and it helps anchor the circadian clock when it gets cool at the same time each night, when you take a shower at the same time each day, etc. Medications— now this is a really interesting one because I mentioned antibiotics before.. But most medications actually can really mess up the gut microbiome. Proton pump inhibitors— these are your antacids— mess up the gut microbes. Metformin, which is a diabetes drug, can— not can, it does— alter the microbiome. NSAIDs like your ibuprofen alters the microbiome. Opioids painkillers, your statins, uh, for high cholesterol, your SSRIs, your antidepressants, and your benzodiazepines and antipsychotics all alter the gut microbiome. Sometimes it's helpful, sometimes it's not. We do want to take a look if somebody started developing symptoms after they started taking a particular medication. It could be that the microbiome is getting altered. They need to talk with their doctor. Sympathetic dominance is another cause of dysbiosis. When we're constantly in fight or flight, we're constantly secreting stress hormones, we're constantly keeping the stress crew, if you will, of the gut microbiome on duty, and the cleanup crew and the rebalancing crew and, and the repair crew, they start dying off. They can't survive in the same environment as the stress hormones. Pain— well, let me go back to sympathetic dominance. So what we can do as clinicians, help people become more mindful, become more aware of their stress levels. Help them develop downregulation skills. Yes, if they've been chronically stressed, it's going to take a while for the gut to get the message. That's true. If they realize that, then they can persevere in practicing their downregulation skills. Helping them take time out each day— you can take little mini relaxation snacks, or parasympathetic snacks, if you will, a minute and a half, 5 minutes during a break to slow their breathing. If they don't want to focus on their internal sensations because it's too triggering, get one of those pulse ox machines and they can just slow their breathing and watch their heart rate drop. That helps activate the parasympathetic nervous system, gives the body a break, if you will. And over time, they will start to feel more empowered when they notice they're getting revved. They start to feel more empowered to put the brakes on early so we don't get into full dysregulation. Chronic pain-related stress also alters the microbiome and intestinal permeability. We need to work with their multidisciplinary team. We need to encourage them to advocate for themselves with their multidisciplinary team regarding the, um, type, um, duration, intensity of their pain. And we can work with them on cognitive behavioral pain management strategies. Acceptance and commitment therapy, super helpful. Guided imagery for pain, amazingly helpful. There are things that we can help people do to address their pain-related thoughts and their pain-related attention. When you focus on something and how much it hurts, it keeps hurting, um, and sometimes feels like it hurts more. Helping them turn their attention to something else— is it making the pain completely go away? No, it's telling their brain not to focus on it as much. That actually can help downregulate. Downregulation skills themselves— if they're just focusing on slowing their breathing and reducing their heart rate, they're focused on something besides their pain. That can be one of the easiest things to focus on. Um, and I do have an entire video on pain management strategies and guided imagery for pain. In terms of diet, we're not going to prescribe any particular diet unless you're a registered dietitian, but we can educate people that prebiotics, which are your— which come from fiber, are really essential to produce those short-chain fatty acids that feed the gut microbiome. Eating vegetables, apples— apples are a great source of fiber. Um, even drinking, um, chicory tea, which has inulin in it, that is a great fiber, um, or that can be processed by the gut. But anything with fiber in it can be really helpful in feeding those bacteria and keeping them happy. Probiotics— these are your fermented foods: sauerkraut, kefir, kimchi. Most people can find at least one fermented food that they don't absolutely hate. Anti-inflammatory diets typically are high in prebiotics and probiotics. We want to encourage them to look to increase the number of non-animal-derived foods in their meal plan, in their diet. I'm not saying give up ham or bacon or whatever it is that, that they like, but balancing it so they're not complete, um, carnivores. They found that processed foods and animal-derived foods were consistently associated with higher levels of inflammation-promoting bacteria, while plant foods were associated with beneficial short-chain fatty acid-producing bacteria. Bananas are plants. Mangoes are plants. There's lots of fruits out there that are really yummy that are plants. So they're— for most people, they can add a little bit of plant-based food to their diet. Insulin resistance is another problem that causes dysbiosis. When— and you don't have to have diabetes, even non-diabetic insulin resistance changes the gut microbiome. When your blood sugar gets high because you're insulin resistant and metabolic dysfunction, uh, change the gut High blood sugar and metabolic dysfunction change the gut environment, killing off beneficial bacteria, especially those butyrate producers. So those are the ones that produce all those bacteria that are supposed to produce the short-chain fatty acids. High blood sugar kills them off. Uh, that's not good. And it allows inflammatory bacteria to overgrow. Not only are the, the short-chain fatty acids not being produced, that means the gut loses a significant source of energy and of anti-inflammatory stuff in it. It's really not good in terms of insulin resistance. We want to help people recognize how stress triggers your body to dump blood glucose. And if you're constantly stressed and you're constantly dumping glucose, then you're very likely to develop insulin resistance, which is why learning how to downregulate that nervous system is so important, because it can help us maintain, um, insulin sensitivity. Intermittent fasting is very good for helping develop insulin sensitivity. Not everybody can do it, but it's another one of those tools that some people implement. Even just going 12 hours— if you finish dinner at 6 and then you eat breakfast at 6, that gives your body theoretically 12 hours without being flooded with blood sugar, assuming you didn't have a major stressor in there somewhere. Interpersonal stressors like isolation also decrease gut microbiome diversity and cause more compositional fluctuations. Isolation and loneliness is a huge issue for a lot of people right now, and the stress of that not only is it changing the composition of the gut microbiome, it also means they're not producing as much oxytocin, so they don't even have the desire to tend and defend. Rejection and exclusion— I thought this one was a really interesting study. People who feel rejected and excluded— not just isolation or loneliness where they don't feel like they don't belong, but when they feel like they're actively rejected or excluded— is an interpersonal stressor. Yeah, that's not a surprise, but it alters the microbiome, and not for the good. Intergenerational trauma also alters the gut microbiome because the birth mother is passing on a dysfunctional microbiome to their child, who probably doesn't heal their microbiome, and that is passed on. Even if they try to heal their microbiome, if they haven't healed their trauma, microbiome's going to stay a little wonky. Helping people identify sources of rejection and exclusion and issues related to intergenerational trauma that may be continuing to keep their stress response triggered and maybe continuing to be keeping their microbiome dysfunctional can be helpful. We can help them process some of these things— how to manage feelings of rejection and exclusion, um, FOMO, not getting enough likes on posts, you know, all that stuff that we see on social media. If it were me, I would say just stay off of social media, but that is not generationally appropriate, as my son would tell me. So low self-esteem and low self-efficacy, how we feel about our own acceptability and our own capability of having a rich and meaningful life, impact our stress level, as do poor boundaries and attachment issues. These are all Clinical Issue 101 things that I'm sure you've treated many, many times before. However, recognizing stress disrupts the microbiome— stress triggers inflammation, which disrupts the microbiome. So we're disrupting the microbiome in multiple ways. So the more unnecessary stress we can eliminate and unavoidable stress we can mitigate, the better the chance is that the person can develop a healthy gut microbiome. Emotionally, anxiety and anger, they're stressors. They're going to alter the microbiome, and an altered microbiome, as we mentioned earlier, actually causes the brain to perceive things more things as threatening. People who feel depressed, they feel hopeless or disempowered and helpless and unsafe. That's stressful. That's the definition of trauma— feeling disempowered and unsafe. We want to recognize that even if it's not something that's hugely overwhelming, it adds up. Everything is additive. All of our stressors are additive. Until finally the brain goes, whoa, I'm overwhelmed, I just can't, you know, this is unsafe, we're completely helpless, we're completely overwhelmed. Helping people identify the things over which they do have power, the aspects of situations that they can control, and the ways that they are safe or can help themselves get and stay safe We want to move toward empowerment. Grief— everybody experiences it. It's not avoidable a lot of times. Most of the time, grief is a combination of anger, anxiety, and depression. Do we want to encourage people to get over their grief? No, that is not appropriate. Everybody has the right to move through their grief process at the rate that is appropriate for them. However, recognizing that while they're grieving, their microbiome is going to be altered. They may have more pain, they may have more sleep disruption, they may have more irritability. Um, you know, the list goes on. Acknowledging that and saying, okay, what can we do to support you in living your rich and meaningful life to the best degree possible while you're grieving. Cognitively, people experience pessimistic interpretations, makes them feel less empowered. What can we do? Help them identify, feel— that's the mnemonic that we use— the facts in context, exceptions to them saying this happens always or never, explanations other than them that might be causing this, and the likelihood that their worst-case scenario is going to happen. So help them cognitively process their interpretations of events. Help them process their cognitive distortions, again with FEEL— facts, expectations, explanations, and likelihood. A lot of people have a trauma history. Traumas vary, but until those people feel safe and empowered to— in their own skin— and safe and empowered to move toward their rich and meaningful life, they will chronically have some level of stress. We want to approach it sometimes, instead of saying, what are your traumas, saying, what is it that's keeping you from feeling safe and empowered right now? We want to examine their core beliefs. If they internalized core beliefs that they were useless, that they are unlovable, that people always leave, um, obviously that's going to contribute to a lot of stress and anxiety and dysbiosis. What are their core beliefs? And let's explore those in a fact-based, through a fact-based lens, and let's decide whether those core beliefs are still accurate or not. Sometimes they may say yes. All right, it's not for me to tell people what's right to believe and what's wrong to believe, but we will walk through the process and say, in this context, at this time, are those core beliefs still accurate? And weak executive functioning skills also cause dysbiosis. When you have difficulty focusing and concentrating in a neurotypical world, it's stressful. When you are out in public and you're being bombarded by all these sounds, smells, sights, whatever, it can feel overwhelming and it can be hard to filter that out, focus your attention, concentrate, uh, plan, organize, etc. For a lot of people, we can work on it both ways. We can help them identify strategies to support their executive functioning skills where they are right now. Scaffolding. If you're having difficulty remembering things, write it down. There's nothing wrong with it. If you're grieving, if you're not getting good sleep, maybe you've got a new kid at home, all right, you're not going to remember everything. Your brain is stressed right now. So let's identify tools that can help support you and reduce unnecessary stress while you are healing from whatever's causing that, and that will avoid worsening the, the gut dysbiosis and potentially allow it to heal. Environmentally, all of your forever chemicals— PFAS, BPA, parabens, etc. Plus fluoride and chlorine damage the intestinal barrier and alter the gut composition. Now, little bits of fluoride are not supposed to be bad, but how much is a little bit? How much is too much? There's lots of argument for those people that are in, um, cities that still add chlorine and fluoride to the water. If people are drinking a lot of the water plus using fluoridated toothpaste they may be getting too much fluoride. Not for us to say, but we couldn't educate them and have them talk it over with their doctor. But those things do damage the intestinal barrier. People who experience a sense of unsafeness in their environment, overcrowding, or food and shelter instability— guess what? They're stressed, and that stress disrupts the microbiome. We can help connect them to agencies and services that can reduce the, um, reduce this stress to the extent possible. There are programs out there to help with rent, to help with electricity, to help with food. You know, call your local United Way and connect your client to that person. And sensory over- or understimulation can cause dysbiosis.. You want it that Goldilocks principle where it's just right, which is what they call environmental enrichment. Um, you don't want to overwhelm yourself, but you don't want to underwhelm. When you have just the right amount of stimulation for you, it promotes beneficial gut bacteria, increases short-chain fatty acid production, and supports brain plasticity. And finally, spiritually, People who have a lack of connection and direction, they feel like they're just overwhelmed and floundering all the time. They're like, what's the point? I don't know why I'm here. I don't have a direction. That can be very stressful because then every decision you've got to make is, you know, is this going to lead me out of this quagmire or am I going to still stay stuck in this quicksand? Research has shown that helping them identify a higher purpose in life— not necessarily a higher power, but a higher purpose in life— was associated with a healthy microbiome. If they have a direction that they're working toward, it helps improve the microbiome. Intensive meditation retreats have also been shown to improve the microbiome, partly because they're activating the parasympathetic nervous system over multiple days and they're eliminating a lot of unnecessary stress. Most meditation retreats, you're not going to have your digital devices with you. You're not going to have the television and everything else. You're actually unplugging, and it does wonders for helping rapidly restore the microbiome. Regular physical activity increases gut microbial, microbial diversity and enriches beneficial short chain fatty acid-producing bacteria. Doesn't have to be intense exercise, any sort of physical activity helps. Nature and green space and pets are also, interestingly enough, associated with increased microbiome diversity. For the nature and green space, they actually looked at young children and they measured the bacteria and the serotonin levels in their feces and found that after exposure to nature and green space for an hour a day for a week, the microbial composition of their feces improved significantly. The gut microbiome can cause distress and is disrupted by distress. Chronic stress leads to enduring changes in the microbiome. Since hormones, neurotransmitters, and the HPA axis are all impacted by the microbiome, it is an essential target for treatment.