How many of you watch Hoarders on A&E?
For those of you who don’t know what Hoarders is, it’s an American reality TV show that each week profiles a couple of people or families who just can’t throw anything away, ever. As a result, their homes or apartments are full of every imaginable item under the sun, much of which anyone would consider trash. It’s common to see the occupants crouch under their ceiling as they climb their way across a room stuffed with possessions or have stacks of books, boxes or clothes precariously perched along narrow walkways ready to collapse and smother them at any moment. As for the insects and vermin that often live in these dwellings, well, let’s just say you have to see it to believe it.
Hoarding is an extreme anxiety disorder. This anxiety is often writ large on the faces of those afflicted when the film crew, cleaning brigade, therapist, organizer, family and friends show up to help clean and straighten up these homes. The hoarder’s reaction to the cleaning process can range from extreme anger to intense sadness and every mood in between.
This being television, the various mental health experts on the show will point to some past traumatic event in the hoarder’s life to explain this self-defeating behavior. Things like a death in the family or being divorced or losing a job—all are used to explain why this person began hoarding. However, many times there really isn’t any one event they can highlight or the past event is nothing out of the ordinary for any normal life.
Many of us also experience traumatic events but don’t begin hoarding possessions until city authorities or Child-Protective Services comes knocking on the door. This isn’t to say intense traumatic events can’t initiate hoarding behavior. I just don’t buy that it’s enough of an explanation for the behavior continuing year after year.
As I can’t help but notice what people eat (much to the annoyance of friends and family), I can’t ignore the mountains of empty soda bottles, processed food containers and discarded fast-food wrappers mixed within the hoards of these folks. As very few of these people have functioning kitchens, it’s not at all surprising that they eat the way they do.
Nevertheless, none of the therapists or organizers ever suggest that this mental illness may be caused by diet or an ongoing physical illness. We are all led to believe that the problem is entirely in their head and with just the right amount of talk therapy, perhaps a pharmaceutical or two and an organizer, all can be made normal.
While this belief may satisfy the craving for a simple explanation by a perplexed television audience, it’s simply not true. As you know from my posts on leaky gut and the hypothalamic-pituitary-adrenal axis and depression, endotoxins and other antigens entering systemic circulation from the gut can affect the brain causing a whole host of mental states, not least of them anxiety.
So what is this thing called anxiety?
According to Taber’s Medical Dictionary anxiety is:
“A vague uneasy feeling of discomfort or dread accompanied by an autonomic response; the source is often nonspecific or unknown to the individual; a feeling of apprehension caused by anticipation of danger.”
Anxiety disorder is defined as:
“…any of a group of mental conditions that include panic disorder with or without agoraphobia, agoraphobia without panic disorder, simple (specific) phobia, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, generalized anxiety disorder, anxiety caused by general medical conditions, and substance-induced anxiety disorder.”
Finally, generalized anxiety is:
“…excessive anxiety and worry predominating for at least 6 months. Restlessness, easy fatigability, difficulty in concentrating, irritability, muscle tension, and disturbed sleep may be present. Adults with this disorder often worry about everyday, routine circumstances such as job responsibilities, finances, the health of family members, misfortune to their children, or minor matters such as being late or completing household chores. Frequently they experience cold, clammy hands; dry mouth; sweating; nausea or diarrhea; urinary frequency; trouble swallowing or a “lump in the throat”; an exaggerated startle response; or depressive symptoms. The intensity, duration, or frequency of the anxiety and worry is far out of proportion to the actual likelihood or impact of the feared event.”
Whew! I think that about covers it, don’t you?
So no surprise to you, dear reader, today’s post will cover how what happens in the gut can cause mental dread separate and apart from life’s anxiety-provoking events.
Most of what we know about how gut flora affects the brain is derived from studies done on germ-free rodents. A germ-free rodent is just that, an animal whose gut is free of bacteria, both good and bad. This is accomplished by surgically removing baby rodents from their pregnant mothers and keeping them in a sterile environment after birth. It may also be accomplished by giving animals broad-spectrum antibiotics that kill off any microbes in their digestive tract.
These germ-free animals have some interesting physical characteristics. They have greatly enlarged cecums, reduced intestinal surface area, altered villi and compromised immunity demonstrated by the fact that they don’t mount a normal immune response to infections from gram-negative bacteria.
Inducing stress in these animals by using a mild restraint causes an exaggerated release of ACTH from their pituitary gland and cortisol from their adrenals in comparison to controls. In other words, stress activates their HPA axis like nobody’s business. If bacteria-rich fecal material is transplanted from healthy-control mice to germ-free mice, their stress response is decreased and partly normalized. Further colonize these animal’s gut with Bifidobacterium infantis and they become totally chill. Pretty interesting don’t you think?
In 2007, researchers fed mice with Lactobacillus rhamnosus for over 28 days resulting in animals with lower levels of plasma cortisol. Also observed were reduced levels of depression and anxiety.
I know, I know. You’re thinking how the hell did the researchers know the little buggers were less depressed or anxious? Did they put them on a miniature couch and ask them a series of questions while puffing on a pipe?
Ah no. To assess depression, they used a forced swim test that observed how hopeless the mice became after a certain amount of time swimming but getting nowhere fast. The theory being that if they weren’t hopeless and depressed they’d be paddling their little whiskers off instead of giving up and trying to join SpongeBob at the bottom of the tank.
As for anxiety, they place mice in what is known as an elevated plus maze which has open and confined spaces. The longer the mice stay in confined versus open and more vulnerable areas, the more anxious they are judged to be. Aren’t you grateful you’re not a lab mouse?
What’s also fascinating is that research has shown that effects on both depression and anxiety are not only mediated by compromised intestinal barrier function. It appears bacteria, both good and bad, can communicate with the brain via the vagus nerve.
The vagus nerve is the nerve connecting your brain to your gastrointestinal tract among other organs. Cut the vagus nerve in these rodents and the depression and anxiety reducing effects of beneficial bacteria disappears. So not only are gut flora mediating gut barrier function, they are also directly communicating with the brain via the vagus nerve. Cue the eerie SciFi music!
In a recent trial in female Wister rats, those fed Lactobacillus farciminis for two weeks produced fewer stress hormones than non-probiotic fed rats when subjected to a stressful situation. The stressful event involved having their movements restrained by a confining harness for two hours. While they were able to move about the cage, they were unable to groom. You can imagine how traumatic this was. What woman (or man) wants to be caught dead hobbling around a cage with unkempt hair and no product?
In this illustration, you can see the effects on ACTH and the stress hormone cortisol. The squares are rats that were similarly stressed but did not receive earlier Lactobacillus treatment. The probiotic rats are represented by the triangle and the control rats, who had not been harnessed, are the circles. As you can see, the Lactobacillus-stressed rats showed levels of ACTH and cortisol that were not much different from controls.
This chart shows the levels of inflammatory cytokines between different sets of rats. In the sham or control rats (sham-PRS), those fed Lactobacillus represented by the shaded area either saw no statistically significant change or showed a lowering of cytokines. In the stressed group (PRS), those receiving the two-week Lactobacillus treatment before the harnessing experienced far less inflammation than the non-treated stressed rats although their levels were higher than the controls.
What this demonstrates, at least in these rats, is that having a healthy gut flora protected against increased intestinal permeability, translocation of endotoxins and antigens from the lumen and activation of the HPA axis. But does this hold true for humans? Glad you asked!
What follows are the results of a double-blind, placebo-controlled pilot study using probiotics to treat the emotional symptoms of subjects afflicted with chronic fatigue syndrome (CFS).
CFS is marked by incapacitating fatigue lasting six or more months. Decreased physical, cognitive and social function is part of this syndrome. It affects men and women of all ages and races. Common symptoms include irritability, substantial impairment of short-term memory, sleep problems, dizziness, light-headedness, heart palpitations, appetite changes, shortness of breath, recurring sore throat, swollen glands, low-grade temperature, bone and muscle aches. Emotionally, depression and anxiety are common which is why I’m including CFS in this post.
Oh, one other thing. Over 70% of CFS patients have irritable bowel syndrome. Go figure!
Back to the study.
Thirty-nine CFS patients were randomized to either a group consuming Lactobacillus casei containing 8 billion colony-forming units for eight weeks or a control group consuming a placebo with the same taste and appearance. Thirty-five completed the trial. Two patients from each group dropped out for reasons unrelated to the study.
Compared to the control group, the Lactobacillus group showed significantly increased levels of both Lactobacillus and Bifidobacterium in their stool after treatment. The increase in bifidobacteria is interesting as this is the predominant beneficial gut flora in the colon and wasn’t supplemented in the study. This means that supplementing with Lactobacillus has a favorable effect on gut flora in the colon as well as the small intestine.
Utilizing the Beck Anxiety Inventory test to assess levels of anxiety in both groups, those taking the probiotic experienced a significant improvement in anxiety compared to the placebo group.
So putting both the animal and human trials from this and my previous two posts together, increased intestinal permeability due to disordered gut flora will:
- Increase the translocation of immune provoking endotoxins and antigens from the gut lumen to systemic circulation,
- provoke inflammatory cytokine signaling,
- increase inflammation throughout the body and central nervous system,
- trigger increased production of the stress hormone cortisol and its precursor ACTH via stimulation of the HPA axis,
- decrease the level of tryptophan,
- alter the level of serotonin in the central nervous system,
- increase the level of toxic metabolites that injure brain cells via increased production of 3-hydroxy-kynurenine and quinolinic acid,
- increase the odds of developing an autoimmune disease,
- make you feel depressed or anxious or both, which will cause even more cortisol release and further compromise gut-barrier function.
Many people, doctors and therapists included, believe that mental illness has nothing to do with the gut. Sorry, wrong answer. It has everything to do with the gut.
It’s this misguided assumption that causes many celiacs, for example, to go undiagnosed for an average of 11 years in the United States! That’s eleven years of seeing doctor after doctor after doctor who never properly diagnose the condition. Why? Because many undiagnosed celiacs experience NO intestinal symptoms—none, zip, nada. Their symptoms are in the central nervous system: headaches, migraines, anxiety, depression, mood swings, sleep issues, schizophrenia, etc. Only the “lucky” ones have gastrointestinal symptoms that may clue a physician to refer them to a gastroenterologist before more unnecessary suffering and damage are done. And what’s true for celiacs is doubly true for the gluten intolerant and those suffering mood disorders.
Having disordered gut flora is no joke. For those of you reading this who have experienced what it’s like to have a wonky digestion, you already know this. However, to those of you reading this who have never experienced a full-fledged gut revolt, you’re kidding yourself if you believe gut dysbiosis can only affect how your tummy feels or whether you’re able to have a bowel movement in the morning. It affects EVERYTHING, including your mental state. So if anxiety or other mood disorders plague you, you need to start paying attention to the state of those critters that make your gut their home.
Will taking probiotics and prebiotics help? Yes. Is it enough? Probably not.
As tempting and financially rewarding as it would be for me to say otherwise, I would be lying to you if I said your salvation is available solely in a pill or a powder. Diet, stress, drugs (both legal and not), environmental toxins, etc. can have a huge impact on your beneficial gut flora. I’ve covered this in my series on small intestinal bacterial overgrowth so please read or review what I wrote there to understand where I’m coming from and what you need to change in order to get better.
In dealing with anxiety, depression or other mental issues, don’t expect overnight results with lifestyle change and prebiotic/probiotic treatment. You didn’t get here overnight and you sure as hell ain’t going to cure it overnight. Americans are an impatient bunch and want quick results, but the body doesn’t quite work that way, especially with something like gut dysbiosis that may have been present since birth.
I also warn against chowing down on large quantities of prebiotics and probiotics. You risk giving yourself a Herxheimer or die-off reaction. This is a reaction to too many gut pathogens, either bacteria or yeast, dying off in large numbers because of their displacement by beneficial bacteria. Do this too quickly and you risk overwhelming your body’s ability to clear them from circulation.
I’ve seen people break out with pretty bad skin rashes or feel like they’ve come down with a mild cold or flu when this happens. If this occurs, reduce, but don’t stop, your prebiotic/probiotic until symptoms clear. I can’t speak for other brands on the market but as far as our prebiotic and probiotic, following the recommended dose should be safe for most adults. However, if die-off is uncomfortable, reduce the amount you take. Because our probiotic can be cut into smaller pieces without compromising its ability to survive stomach acid, it’s easier to reduce the dose than with other brands, which is another reason I chose this particular manufacturing process.
Remember, this isn’t a race. Healing and sealing that gut will take time.
Generalized anxiety, like severe depression, is the result of a seriously screwed-up gut flora fueling a low-grade blood poisoning. Until this is recognized and dealt with, all the talk therapy in the world will only get you so far.
Ait-Belgnaouri A., Durand H., Cartier C., Chaumaz G., Eutamene H., Ferrier L., Houdeau E., Fioramonti J., Bueno L., Theodorou V. (2012). Prevention of gut leakiness by a probiotic treatment leads to attenuated HPA response to an acute psychological stress in rats. Psychoneuroendocrinology, http://dx.doi.org/10.1016/j.bbr.2011.03.031.
Dinan T. G. and Cryan J. F. (2012). Regulation of the stress response by the gut microbiota: Implications for psychoneuroendocrinology. Psychoneuroendocrinology, 37: 1369-1378.
Rao A. V., Bested A. C., Beauline T. M., Katzman M. A., Iorio C., Berardi J. M., Logan A. C. (2009). A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathogens, 1-6.
Rousseaux, C., Thuru, X., Gelot, A., Barnich, N., Neut, C., Dubuquoy, et al. (2007). Lactobacillus acidophilus modulates intestinal pain and induces opioid and cannabinoid receptors. Nature Medicine, 13: 35—37.