How the Gut and Mental Health are Related
Gut issues, IBS and Mental Health
Many years ago when my daughter ended up in A&E with abdominal pain, the doctor on duty asked her about her history. When she explained that she had been given the diagnosis of ‘IBS’ (Irritable Bowel Syndrome), he replied “There is no such thing as IBS”.
You might be thinking ‘What the heck?’
What he meant by this; ‘IBS’ is a name given to a set of symptoms. It's a syndrome and doesn't describe the cause of the abdominal discomfort or the contributing factors.
What are the causes of Gut Issues?
IBS and other gut issues can be triggered by many different things, including poor digestion, dietary triggers or food sensitivities, lack of digestive enzymes, hypochlorhydria (low stomach acid), gut dysbiosis (an abnormal balance of bacteria, viruses or fungi in the gut), SIBO (Small Intestinal Bacterial Overgrowth) thyroid issues, stress, parasites… or a mix of a number of the above.
Therefore the diagnosis of ‘IBS’ or undiagnosed gut issues requires further investigation.
Gut issues such as IBS are not usually about the food - food elimination diets are rarely the answer.
What Impacts The Gut Microbiome?
The gut microbiome is a complex mix of microbes that reside mostly in your large intestine and have established themselves since your birth. They are impacted by how you were born (ie whether you were born via caesarean or vaginally), your external environment (your exposure to dirt or antibacterial products), whether or not you have had antibiotics (and how much you’ve had) and probably the thing you have most - control over - what you eat.
Lack of the right balance of gut microbes can cause havoc (as you may well know if you’ve ever experienced food poisoning!)
Sometimes, however, the gut microbiome gets disturbed on a more subtle but chronic basis. This can occur due to a mix of:
A bout of food poisoning from which the gut doesn’t quite recover
Poor diet lacking in polyphenols, fibre and nutrients.
Ingestion of substances (often as part of junk food), including emulsifiers, plastics (yes), toxins, artificial sweeteners and other non-food substances
Antibiotics which significantly reduce bad and good bacteria (and can take over a year for the good microbes to re-populate).
Parasites (more common than you think!)
Food sensitivities
Our mental state (yes, it's bi-directional), especially stress.
Bloating, gas and gut issues occur for many reasons - only some of it is due to what we eat.
How does a disturbance in the microbiome impact your health?
A disturbance in gut microbes can impact you in several ways.
You might get: chronic indigestion, constipation, diarrhoea (or the joy of having both), gut pain, bloating, general discomfort, mood disorders, skin disorders, heartburn, odorous flatulence, immune system issues and a myriad of conditions that are indirectly related to your microbiome.
If you have several gut issues - you may go to your GP. They may run a very basic stool test, do a few other tests as they feel they need to and will often say ‘ there’s nothing wrong’.
You may then receive a diagnosis of IBS. You may be given some suggestions about eating a FODMAP diet (FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols) - a diet which is low in a number of carbohydrates - which may help relieve your symptoms.
The issues with a FODMAP diet
A FODMAP diet is designed to be a short-term intervention to eliminate the most problematic foods (ie give you some relief from your symptoms) while you work on improving your gut health. Ideally - this should be done with the help of a dietitian or health professional (but often this is not available). Unfortunately, people often go on a FODMAP diet - but never come off them. This can lead to more gut issues down the track - as taking out specific food groups gives the good (and the bad) microbes less to live on - depriving your microbiome of good food sources.
The FODMAP is a great diagnostic tool to figure out what foods are causing an issue and provide short-term relief - it is not a long-term solution to IBS or other gut issues.
What does the gut have to do with overall health?
The microbes in your gut (large bowel) have a significant role to play in all areas of your health. They send messages to each other about the state of the gut, help metabolism (and therefore you to absorb) nutrients (especially B vitamins), help to produce other vitamins, produce anti-inflammatory SCFA (Short Chain Fatty Acids) and defend against pathogens (bad bugs!). They also help to recycle hormones such as estrogen and help to metabolise medications.
A healthy gut microbiome is essential for serotonin (and other neurotransmitter) production. Your immune system function relies on having a healthy microbiome to deal with unwanted bacteria, pathogens, viruses and parasites. And a robust microbiome promotes a healthy barrier between your gut and your bloodstream, preventing things such as endotoxins and lipopolysaccharides (toxins from decaying bacteria) from entering into your blood. An unhealthy gut can contribute to systemic inflammation - contributing to many health issues from cardiovascular disease to arthritis to mental health disorders.
Your microbiome is such an important part of your overall health - it is essential for it to be healthy, robust, diverse and well-feed.
The Relationship between Mental Health and Gut Health
People with IBS and IBD (inflammatory bowel diseases like Crohn’s and ulcerative colitis) are more likely to get diagnosed with depression or other mental health issues. And people with mental health issues have higher rates of IBS.
Unfortunately, IBS (and other gut issues) and mood issues can become a “vicious cycle” where each one worsens the other.
When we are depressed, anxious or struggling with chronic stress - this can change what we eat, how we eat and more importantly our ability to digest our food. This can cause nutrient depletion, further bloating and discomfort. Some medications often prescribed (such as Omeprazole/Losec) can cause further long-term problems as they reduce gastric acid production which is needed to digest food well and to support a healthy microbiome.
Microbiome health can impact mental health.
(See more on neurotransmitters and their impact on mental health here and how diet impacts mental health here)
The Perfect storm for Gut issues to arise
You may have been someone who never had issues with your gut - but over time began to develop gut issues. A sequence of events may have created the ‘perfect storm’ for gut issues to arise - and it often looks a little like this:
You had an illness or acne and you were placed on a few doses of antibiotics and/or
You may have had a poor diet, went vegan for a few years (and didn’t do it well) and/or
You had an episode of food poisoning and/or
You then experienced a period of significant stress (cortisol - the stress hormone can create impaired gut-barrier function, as well as a reduction in digestive acid).
Your gut starts to play up - reacting to certain foods, you experience regular bloating, diarrhoea, constipation or indigestion.
Your mood and energy levels may change
If you see your GP around this time with anxiety, depression, irritability, low energy. Your GP may believe you are depressed and suggest anti-depressants or other medication and may give you a separate diagnosis for your gut issues.
But, you may find if you treat your gut issues - your mental health issues will improve.
Did you know that it can take up to two years for the microbiome to recover the bacteria lost following some antibiotics?
A perfect storm for gut issues to arise may include: antibiotics, a period of illness and being under a signficant amount of stress.
What is SIBO (Small Intestinal Bacterial Overgrowth?)
S.I.B.O is one of the common issues I come across when working with people with mental health issues. S.I.B.O stands for Small Intestinal Bacterial Overgrowth.
S.I.B.O is when the bacteria in the large bowel (large intestine) translocated to the small bowel (small intestine).
Where it shouldn’t be.
S.I.B.O can be caused by:
low gastric acid (related to nutrient deficiency, stress or medications)
acid blocking medications (PPI's) such as Omeprazole and Ranitidine
Stress
Constipation
A diet low in Omega Three fatty acids
Normal distribution of bacterial versus SIBO
How to tell if you have SIBO?
S.I.B.O can be diagnosed with a breath test, but there are a few tell-tale signs that you might have S.I.B.O:
These are:
bloating shortly after eating which causes discomfort
constipation and or diarrhoea
Difficulty digesting certain starches and carbohydrates such as:
Resistant starches (which are great for our gut and microbiota!) such as leftover potatoes and pasta.
Foods such as lentils, chickpeas, green bananas.
Foods which contain inulin - such as garlic, onions and leeks.
If you used to tolerate these foods and now can't - it might be worth seeing if you have SIBO.
Various things can help to treat S.I.B.O including certain probiotics, supplements and lifestyle measures.
Treating Gut Issues
If you struggle with:
- heartburn
- stomach pains, bloating or cramps
- constipation (moving less than daily and or hard poops)
- diarrhoea (or a mix of both)
- unsettled, acidy or grippy stomach
- poor appetite
- difficulty digesting fats
- have undigested food in your stool (poop)
As well as mood, immune or skin issues - these are all signs that your gut may not be functioning well.
One thing you can do is do a complete microbiome test - to take a deep dive into looking at what is going on in your gut (I’ll be writing more on this soon). These tests are expensive - but well worth it if you’ve been struggling for years with no resolution.
There is a lot we can do to support our gut health and doing these things may improve how you feel mentally.
You can go on a FODMAP diet but remember FODMAP can help with the symptoms, it rarely addresses the underlying problem.
And, despite how it may feel - food is not usually the problem!
What you can do to support your gut health
Eliminating certain foods (gluten and dairy are often big offenders), reducing our stress, adding pre and (specific) probiotic foods, and improving digestion (through supplementing or even simply chewing our food well!) can all make a huge difference.
Some small steps
Here are some easy things you can do for yourself:
Start a Food Mood Poo’d diary (download this free here) and notice the correlation between food, gut symptoms and mood.
Slow down and chew your food well (your stomach does not have teeth!)
Practice a regular relaxation technique and do this before eating (simple deep belly breathing for example)
Increase coloured fruit, vegetables and high-fibre foods which help to feed the microbiome
Have a wide and varied diet - aim for 30 different plant foods in a week (fruits, vegetables, whole grains, herbs, spices, nuts, seeds)
Support the good bacteria in your gut by adding fermented foods (do this gently and stop if this makes things worse which it can do!)
Have a four-hour break between eating to support gut function (specifically the migrating motor complex)
Cut out alcohol and artificial sweeteners and other ‘non-food’ ingredients (junk food)
Add a bit of lemon juice or apple cider vinegar pre-meals to improve gut acidity
Some supplements may help - including probiotics and herbal ‘anti-microbials’. There has been some research done on the product Iberogast - although this appears to be difficult to access in New Zealand.
If symptoms persist, see a health professional who has experience in dealing with gut health issues - you can book an appointment directly with me here. I have done hundreds of stool tests and dealt with hundreds of people with significant gut issues!
Most importantly - understand the relationship between gut health and mental health - sometimes your mental health isn’t in your head!!
Getting help for gut & mental health
If you think you would benefit from a holistic approach to mental health and your gut issues - please get in touch here.
Helen is a registered nurse & life coach, specialising in mental health from a holistic perspective. She is passionate about supporting people to have optimal mental health and well-being.
Based in New Zealand, Helen is available for speaking, education sessions and one-on-one appointments.
Helen Duyvestyn RcN, MHSc
Holistic Mental Health
References:
Bested, A.C., Logan, A.C. & Selhub, E.M. Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part II – contemporary contextual research. Gut Pathog 5, 3 (2013). https://doi.org/10.1186/1757-4749-5-3
Lin HC. Small Intestinal Bacterial Overgrowth: A Framework for Understanding Irritable Bowel Syndrome. JAMA. 2004;292(7):852–858. doi:10.1001/jama.292.7.852