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Heal Your Gut, Heal Your Brain

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Are you among the 20 percent of adults suffering from anxiety and depression? Find out how nourishing your gut microbiome can make you happier and more relaxed.

leaky gut and anxiety
There is a strong connection between the gut and the brain. AntonioGuillem/istock/Thinkstock

In my work, a significant number of patients list anxiety or depression as one of their top three health concerns. This is not at all surprising given that anxiety and depression are two of the most common mental health issues in our society, with anxiety disorders affecting approximately 18% of adults in the U.S. (1) Anxiety and depression are not the same, but they are often experienced together as a complex set of emotional and functional changes. (2)

Both anxiety and depression, along with other mood and neuropsychiatric disorders, such as eating disorders, bipolar disorder or sleep disorders, generally result from a complex interplay of factors. These may include a combination of nutritional, physical, environmental, social, emotional, and spiritual factors, affecting your genetic tendencies and brain biochemistry (meaning that your neurotransmitters, or the chemical messengers within your brain, can be affected by these key components of well-being). You can think of anxiety and depression as disruptions in brain health.

Treating the Cause Not Just the Symptoms

While conventional medicine, not surprisingly, offers medications to treat the symptoms of anxiety and depression with somewhat limited success (data suggests that 30 to 40% of patients do not respond to current drug strategies), we take a very different approach in functional medicine. (3, 4) It’s important to recognize that medication, particularly antidepressants, can be essential for some people, particularly those with more severe depression, and a decision to start or stop antidepressants needs to be discussed with your health care provider. I never recommend coming off antidepressants too quickly, and there are times when patients clearly benefit from the support of these medications.

What surprises many new patients who ask for help with their anxiety or depression is that we start by looking at the health of the gut. For those of you who have followed this blog for any amount of time, you’ve probably picked up on a common theme here that you have to have a healthy gut microbiome for optimal well-being.

Having trained in conventional medicine, this idea was not intuitive to me even five years ago. But now, after reading the scientific literature on the microbiome-gut-brain axis, and working with patients to heal their gut and seeing the incredible improvements in mood, I’m convinced this is the starting place to heal anxiety and depression.

Anxious, stressed, or depressed? Healing your gut may be the solution. #guthealth #microbiome #mentalhealth

A Growing Body of Evidence Shows That Our Beneficial Gut Bacteria Support Positive Mood and Emotional Well-Being

The gut microbiome, which we’ve discussed in a number of prior articles and podcasts (here and here), refers to the microorganisms, predominately bacteria (somewhere on the order of 10 to 100 trillion) and their genes, living within the human gut. Many of these microorganisms are in fact essential for good health. When the balance of beneficial bacteria in the gut is disrupted, disease can occur.

The relatively new understanding of how microorganisms affect every system of our body, along with the incredible volume of research on the microbiome is leading to a shift within medicine, and specifically a shift towards appreciating how important it is to care for our healthy gut bacteria.

Differences in the Gut Microbiome Exist between People with Anxiety and Depression and Those Without

Numerous studies in animal models show convincing evidence of a strong relationship between the gut microbiome and mood. For example, studies have found significant differences in the types of gut bacteria in animals exposed to various types of stress such as maternal separation early in life, social stressors, or prolonged restraint. (5, 6, 7)

One study, published this month, examined the specific differences in the bacterial make-up of the microbiome in patients with major depressive disorder in comparison with healthy individuals. (8) Significant differences were identified between these two groups. Additionally, the severity of depressive symptoms was related to the amount of a specific bacterium. A lower relative abundance of Faecalibacterium was associated with more severe depression.

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Altering the Gut Microbiome with Probiotics Can Decrease Feelings of Anxiety and Positively Affect Emotional Processing

Several studies show evidence for reduced feelings of anxiety and improved aspects of well-being after taking probiotics. (9, 10, 11)

One study used functional MRI (magnetic resonance imaging), which is a type of imaging that looks at brain activity, to evaluate the influence of gut microbes on emotional behavior and underlying brain mechanisms. (12) Specifically, three groups of women were given either fermented milk with probiotics, non-fermented milk, or no intervention, twice daily for four weeks. Functional MRI was performed both at the start and completion of the study to look at brain activity in response to an emotional attention task.

The women who consumed the fermented milk with probiotics showed changes in regions of the brain crucial in emotional processing. This study provides further evidence that supporting the gut microbiome can provide measurable changes in emotional processing within the brain.

Additional support for the connection between the gut microbiome and mood came from a study that showed the use of specific probiotics significantly decreased anxiety-like behavior in rats and reduced psychological distress in humans. (13)

Nourishing Your Beneficial Gut Bacteria Will Also Reduce Anxiety and Decrease Stressishing your beneficial gut bacteria will also reduce anxiety and decrease stress

A recent study evaluating the effects of prebiotics on well-being provided additional evidence of the gut bacteria positively affecting mental health. (14)  Prebiotics are carbohydrates that humans cannot digest, but bacteria in our guts can.

In this study, 45 healthy individuals were asked to take either a prebiotic or placebo every other day for three weeks. Cortisol measurements were taken from saliva samples at the beginning and end of the study to evaluate the hypothalamic-pituitary-adrenal (HPA) axis activity (an important factor contributing to anxiety and depression). After three weeks, the participants completed a series of tests designed to assess how they processed emotional information, such as processing facial expressions of the six basic emotions, and responding to positive and negatively charged words.

The results showed that individuals who had taken the prebiotic had significantly lower cortisol after three weeks, meaning they showed physiologic evidence of a decreased stress response. And the prebiotic group paid more attention to positive information and less attention to negative information when compared to the participants who were given placebo. This suggests that when confronted with negative stimuli, the prebiotic group would have less anxiety, similar to that which has been observed in some people taking antidepressant or anti-anxiety medication.

Use an Integrated Approach

Therapy and, in some cases, antidepressant or anti-anxiety medications can be important pieces of treatment. But if underlying imbalances in the gut microbiome are to blame (which is often the case in our experience), you won’t heal until they are addressed.  This functional medicine approach to mood disorders is something that I frequently find to be more effective than conventional treatments, allowing many patients relief from their symptoms of anxiety and depression.

Amy Nett

About Amy:  Amy Nett, MD, graduated from Georgetown University School of Medicine in 2007.  She subsequently completed a year of internal medicine training at Santa Barbara Cottage Hospital, followed by five years of specialty training in radiology at Stanford University Hospital, with additional subspecialty training in pediatric radiology.

Along the course of her medical training and working through her own personal health issues, she found her passion for Functional Medicine. She works with patients through a Functional Medicine approach, working to identify and treat the root causes of illness.  She uses nutritional therapy, herbal medicine, supplements, stress management, detoxification and lifestyle changes to restore proper function and improve health.

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187 Comments

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  1. I don’t disagree with the power of pro/probiotics, but I wonder if some of the study subjects saw an improvement in their mood because they tried to follow a healthier diet along with the probiotics — whether encouraged to or via their own volition. Eating a nutrient-rich diet lifts one’s mood. Would be interesting to see results adjusted for type of diet.

  2. I just want to share my experience in hopes it may help others and get medical professionals to look deeper into symptoms. I am in mid 40’s and recently diagnosed with Hashimoto thyroiditis with 2 nodules on the thyroid and was experiencing extreme fatigue, confusion and memory issues while trying to care for 2 children under 5 (i.e. recent birth). I went to endocrinologist, cardiologist, family practice doctor and ended up at my gynecologist with more severe symptoms and the beginnings of depression. The confusion and memory issues were taking its toll and the depression was getting worse. I watched Dr. Oz on one occasion and he talked about iron deficiency and to get a real look at it get the Ferritin lab test. I went to my family doctor and requested the test and they thought I was crazy and it would lead to nothing being found as my other labs showed I was not anemic. They did it and it came back that I was low on red blood cells in my bone marrow. He prescribed an iron tablet and I started on it, but after 2 weeks it was not showing any signs of helping anything. I went back to my gynecologist and she changed that iron Rx to Ferralet 90 and in 2 days I could tell it was helping. My fatigue has completely gone away and I have more energy now than when I was in my 30’s. The confusion and memory issues have resolved as well as the depression. Is there a link to all this that goes that deep as if the body can’t produce enough of the building blocks to keep everything on track that it all starts going out of whack? The thyroid is also back in reasonable range, while I am testing better on iron and red blood cells in bone marrow. My gynecologist has said I could stop the Ferralet 90, but I have chosen to keep a maintenance regimen going by taking it every other day and am still feeling good. I am not a doctor only a patient and I am not sure if this will help anyone else or if the medical profession should test further into symptoms of all those dealing with depression to see if there is a link. I lost my sister to depression and she was on Rx for depression which seems to have made things worse. Maybe the link to low red blood cells should be looked at in all cases of depression (and postpartum) as I have noticed looking back that most depressed patients have a washed out look about them.

  3. Very informative article. It’s nice to see this subject finally getting so much attention.
    About 17 years ago I had breast cancer and I found a great doctor who helped me heal my gut and guided me with nutrition and supplements. I finished my chemo feeling the best I had ever felt in my life. Due to the distance I had to travel, I did not continue with this doctor and I did very well on my own until I had a major surgery and other stresses in my life.
    Slowly, I felt my life spinning out of control and I felt like I was on my way to a second cancer. I was having a lot of stomach issues and I spent 2 months eliminating all the possibilities with every scan imaginable (or so it seemed). I realized I had to revamp my diet again and began researching. I went back to the basics and started eating very clean and added prebiotics/probiotics and other supplements needed to heal my gut but I just wasn’t having the results I hoped for.

    I am now under the guidance of a wonderful Dr who has been instrumental in tweaking my diet and getting me on supplements that are more powerful and effective. I have also done a bowel detox and learned that I don’t process carbs well.

    I now feel like a new person! My energy is back. The positive me is back and I don’t feel like my life is spinning out of control. I have a long way to go, but what a change in just 4 months!

    What I feel people should be aware of is it is very hard to have the results you are hoping for without the guidance of a skilled professional. I succeeded in healing my gut once but this second time has been much harder due to different issues. I can’t say enough for getting educated advise geared specifically to your own situation.

  4. Great article, thank you! As someone who has struggled with anxiety and depression for years (due to a brain injury from a car accident) and who is seeing remarkably good changes happen with healing my gut – let me share what is working for me.

    I’m addressing anyone who has to do this w/o benefit of a doctor due to having no health insurance and/or having doctors who just don’t get it, and think the answer to every ailment is their prescription pad.

    …and I’m also addressing people who are disabled, with very limited resources and on Medicare or Medicaid. Even with little money you can make little changes – every week – which will accumulate into healing for you and your mental illness (dysbiosis);

    1. Get in the habit of researching the hell out of your health issue. I spend every available hour digging on the Internet for prebiotic, probiotic, resistance starch, fermentable fiber, fermenting, gut-brain/vagus nerve communication, depression & anxiety and food connections. All the info you need is available, for free, on the net;

    2. Learn to ferment. Sauerkraut as remedy for depression! Our ancestors survived with fermenting food. It is not hard, it’s just a new skill set our mothers didn’t teach us. The (soil-based) bacteria that you need to take up residence in your gut are made available through the organic veggies you grow or buy at the farmers’ market and your home fermenting. You CANNOT buy these bacteria in a pill and even when you use a probiotic pill (soil-based) you simply cannot get the quantity AND variety of good bacteria which your own kitchen and garden can provide, three meals a day;

    3. Make your own yogurt. Most commercial yogurts (even the “good” organic ones) don’t ferment long enough (1 hour or less?!) or, worse, they pasturize the yogurt (which kills the bacteria!!) and add in harmful ingredients. Look up how to make GAPS or SCD 24-hour yogurt; the number of bacteria (billions in every mouthful) in your own yogurt is phenomenally higher than ANY commercial yogurt.

    As you get more comfortable with your yogurt making you can buy individual bacteria to target a mental health issue. I bought B. infantis bacteria and made a single-strain, 24-hour yogurt with it. B. infantis grows tryptophan-serotonin. In my own gut! How cool is that!

    These bacteria (Lb. paracasei, Lb. delbrueckii. subsp. bulgaricus, and Lb. plantarum) make GABA in your gut. So, I gotta find out where to buy them and, hey, can I ferment them in my kitchen and make GABA-yogurt? Actually, delbrueckii is the original yogurt strain from Bulgaria; so they knew how to keep the tribe happy with sour milk thousands of years ago!

    Make kefir – even easier than yogurt and it has more, varied bacteria AND yeasts.

    Find somebody near you who makes kombucha. Barter to get some every week. Kick a@@ healthy for your gut! Learn how to make your own, takes patience but once it’s up and running you have your own supply to bottle up every week.

    However, yogurt and/or kefir and/or kombucha will not re-populate your gut. You need soil-based bacteria! How? Probiotic pills, yes, but more importantly, your own ferments;

    4. Straighten out your diet. Paleo/GAPS/SCD/the Perfect Health Diet/ Chris Kresser (smile)…start researching and get off of sugar, eat loads of veggies, grass fed meats, healthy saturated fats, fermentable fiber, and REAL, unprocessed food (not factory-made food-like-substances);

    5. Join a CSA; buy your veggies DIRECTLY from a farmer. Join a food co-op. Are there Amish farmers near you? Find out and buy from them. Start a garden!!!

    6. Do not make the mistake which VLC/Paleo/GAPS/SCD/AIP etc. diets do, which is to delete fermentable fiber from your diet. That would be A Terrible Thing. There are billions of bacteria in your gut and that is their food. Deprive them of fiber and they die. Learn what they eat – eat it – and they begin to thrive again;

    7. Learn everything you can about fermentable fiber: FOS, GOS, inulin, polysaccharides, starch, fermentable vs non- fermentable starch, resistant starch, etc. You have to learn how to feed the family living in your colon who are ready, willing and able to make you serotonin, GABA and B vitamins which are low in anybody with mental illness. You have a factory which ONLY YOU can get up and online to become operational;

    Every day I now eat things like Jerusulem artichokes or dehydrated plantains or (soaked for 24-48 hours and cooked) lentils or roasted/cooled potatoes to feed the gut bugs. I understand little about what to eat for fiber or which food feeds which bacteria. But every day I learn a new fact and run to the food co-op and buy that food and implement more healing.

    The latest food I am adding in are mushrooms; they provide beta-gluten (I didn’t know what the hell that was a week ago) and they get into our body and help clean up messes and heal us. They are also a powerful, fermentable fiber; gut bugs love them;

    8. Assume that food is your medicine. That is the way humans are supposed to work. Every mouthful counts;

    9. Assume that your mental illness is greatly influenced by the health (or not) of your gut. Learn how to fix it. BigPharma will be very happy to keep selling you pills for the rest of your life (and destroying your gut bacteria as an added benefit); you need to take the reins;

    10. Research probiotics: exact brands, which bacteria do they contain and does it need refrigeration and what is the CFU of each pill. Are they a fly-by-night company (don’t buy their bacteria which are likely already dead: caveat emptor.)

    These things are expensive!!! Make every pill count. Find out which probiotic bacteria you can ferment in your kitchen and save a ton of money. Do you have to take one a day forever? Find out that answer and save money;

    Probiotics are pills. We have been trained to think pills heal. They may not. They are a temporary measure until you can get your own factory up and running. They are an essential fix for most of us but the big change is your daily food and daily ferments;

    11. Research the work of the Orthomolecular doctors. Their body of knowledge via their journal, is online, free for the searching. They began healing mental illness decades ago with the things natural to a human body: vitamins, minerals, amino acids and food. Modern medicine has marginalized their work. They get mental illness and how to heal the imbalances in our body which manifest as “mental” illness. Dr. Carl Pfeiffer is one name; Dr. William Walsh is another. This school of healing understands the power of, for example, one B vitamin (B3) and its power to heal schizophrenia or a combination of deficiencies causing havoc in a human (B6 and zinc deficiencies causing Pyroluria).

    Dr. William Walsh has identified 5 different types of depression, based upon clinical testing of nutritional deficiencies. There is not one type of depression! Find a doctor who will read his book or who was trained by him (good luck, they are few and far between);

    12. Learn about detox. As you shift your gut with food you will experience uncomfortable changes in your body. Take changes SLOW and learn the ancient methods we humans have to get rid of poisons;

    13. Borrow all these new, awesome books on healing you see referenced on the web from your local library (free) or do like my husband and I do: our Fri. night date is to go to our local [big-name, national chain bookstore], buy a cup of tea and a Paleo treat and read the books we find on the web;

    14. Do not EVER give up hope! Find friends (online or at home) to support your rigorous investigations as a citizen scientist! Mental illness stinks but you CAN heal it or make it better;

    15. Go visit the Anxiety Summit, hosted by Trudy Scott. She has assembled an incredible body of experts who understand food, healing and anxiety/depression. The interviews are FREE initially, so you can plug the relevant interviews (date/time) into your calendar and listen – and learn – for free! See:

    http://www.everywomanover29.com/blog/anxiety-summit-starts-next-week/

    16. This takes time. It could take a year …or two. But it is your life and that is A Most Valuable Thing. Invest in you. Eat sauerkraut. Eat cooked/cooled potatoes (RS3) …and leave depression & anxiety in the dust!

    Chris and Amy, thank you for this; you are helping so many people whom our society has marginalized, who live on SSDI or SSI/Medicaid and cannot get help save through blogs like yours. Those of us with mental illness often end up poor and without help or community. (Medicaid understanding fermenting as a medicine for depression and having an ICD-9 code for billing? I don’t think so.)

    Your blog is one way to get the word out. I learn so much from your website and books and you are my go-to guy when there is any new thing I want to try for healing!

    HTH (even 1 person),
    Laura

    PS would you consider a podcast on Pyroluria? Maybe Dr. William Walsh as a guest? (…who lists Pyroluria as one of a subset of those with depression. It’s an underlying factor in large percentages of alcoholism, schizophrenia, depression, ADHD, etc.) …and Trudy Scott who, herself, has Pyroluria, and posts regularly about it. (I got it, too.)

    • What a great list Laura, very thought provoking, thank you and good luck.

      • David, Claire, Angela,

        You’re welcome!

        BTW, I wasn’t clear: it is your own homemade *vegetable* ferments which appear to have the best possibility of colonizing your gut with permanent residents. Milk ferments (lactic acid producers) offer transitory bacteria – which do help your immune system / mood on their way through. But it is your own vegetable ferments (with all those new & different strains of bacteria from your garden, soil, farmers’ market veggies, and environment) which have the likelihood of great diversity in bacteria which will colonize your gut (soil-based bacteria). You will eat them often increasing robust and permanent colonization of your gut over weeks and months of b’fast, lunch & dinners.

        That said, I may still eat my own homemade yogurt and kefirs for the rest of my life as my daily mood medicine. It works, why stop?

        Many rounds of anti-biotics and/or anti-depressants and/or pharmaceuticals over our lives killed off our ancestral bacteria … and seriously jeopardized our immune system which is 80% in our gut. So, as a gardener does with his/her garden, we have to deliberately & methodically create & sustain fertile, healthy “soil” … and re-seed.

        The gut-brain connection is very real and powerful; explore exercises to strengthen vagus nerve communication going from gut to brain. This is also key to positively affecting mood.

        Let me add two very helpful studies to read:

        1. Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry, January 15, 2014

        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904694/

        2. Collective unconscious: How gut microbes shape human behavior [a review]
        Journal of Psychiatric Research, April 2015

        http://www.sciencedirect.com/science/article/pii/S0022395615000655

        If you decide to improve mood / brain function by changing your biome / diet, expect a bumpy ride. Read, research and find other people to learn from. We are all pioneers…and need each other’s support and wisdom as we test the limits.

        Read these three books to learn how to ferment:

        Sandor Katz: The Art of Fermentation & Wild Fermentation
        Kirsten & Christopher Shockey: Fermented Vegetables

        Laura

        • Thanks Laura,
          Actually I already know what you mean about home made fermented veggies from your own garden (or locally grown being the best and most abundant source of beneficial microbes for our gut health. And yes to Katz books – haven’t read the other one you mentioned. I was first exposed to the importance of home fermented foods from Macrobiotics, taught by the Aihara’s. I’d include the use of high quality fermented(unpasteurized non- GMO organic) miso, shoyu and natto. Soy is low on people’s lists of good foods. But I think with proper fermentation these soy foods offer valuable nutrition for gut health.
          And yes I am also learning about ways to stimulate the vagus nerve. We must have some similar sources. Where did you learn about the vagus nerve activation for gut motility? I’m learning about from Kharrazian, Tips and Seibecker.

          I love how you brought all these things together into one list.

          • Hi Angela,

            I started with Dr. Kharrian. I don’t know Tips and Seibecker: any URLS?

            Dr. Art Ayers, at Cooling Inflammation, is a goldmine as re. healing your gut. He is a biologist. Be sure to read all the comments; he actively participates. See:

            http://coolinginflammation.blogspot.com/2008/09/vagus-nerve-controls-intestinal.html?m=1
            and
            http://coolinginflammation.blogspot.com/2009/09/vagus-nerve-controls-gut-inflammation.html?m=1

            IBD and Vagal Nerve Issues: the Gut/Neck Axis
            http://ghn.thegraychannel.com/uncategorized/ibd-vagal-nerve-connection/

            Research Steve Mensing
            -the Longevity Manuever
            -the Dive Reflex

            Aryuvedic Medicine and Buddhists have known about this for thousands of years: meditation; chanting; oil pulling … We are newcomers to the party.

            I love it that singing and humming (and whistling?) stimulate vagus nerve activity. What’s not to like about doing those things every day to help heal your gut!

            I avoid soy cuz of GMOs, round-up and processing with hexane; I would be willing to consider Natto if I knew the source was clean. (Plus, be on the lookout: BigFood has vegans and vegetarians and soy foods in its sights. A biotech company named Seomyx, which has patents on human tastes (!), is working its magic on hiding things like MSG in foods – worse than is already being done w/o consumer knowledge: that is, no labeling required. I read that they are targeting all those soy-based foods which many vegans and vegetarians eat to include new & improved patented “flavors.” I believe Senomyx works with Ajinomoto, the company which owns the patent on MSG. See: http://www.naturalproductsinsider.com/news/2007/05/senomyx-solae-dupont-and-bunge-unite-behind-soy.aspx

            Peruse this whole (informative) consumer-safety website and protect yourself:
            http://www.truthinlabeling.org/senomyx%27s-fake-flavors.htm
            and
            http://www.westonaprice.org/health-topics/new-propaganda-about-msg/
            Laura

            • It will take a while to check out and read all your links….thank you so much for being so generous with your time and writing all that here. I’ll look into it.

              I’d only use soy products that are first organically grown, non-gmo and then cooked and fermented using traditional practices, unpasturized. If you do that then you avoid many of the problems you list.

              As for Natto, I am not even looking for a commercial source. I plan to make it myself. I might need a coach so I’m looking for that too. I’ve heard of making natto with chickpeas…..

            • Big thanks Laura for the generous wealth of info and detail you’ve just given everyone (esp recs for further reading). It’s such a relief to hear from someone else who set on healing their mental health through nutrition. My motivation has been flagging and you’ve given me renewed impetus to stick with the kefir, stop making gorse wine and start fermenting sauerkraut ! Here in the UK Patrick Holford is the hero who brought Dr. Carl Pfeiffer’s work to our notice ; I co-hosted a small regional conference (way back in 2007) : Nutrition and Mental Health which brought NHS health workers and patients together to hear the discussion of methylation – key note speech by Patrick . I’d join with you in thanking Chris and Amy for the quality of information they give (research sources/ studies referenced properly etc) . It’s splendid and I’m very grateful!

              • Dear Rachel,

                Thanks for your comment: a fellow traveller. Yes, the Orthomolecular doctors understand that a mental illness could be a physical manifestation of a deficiency (or abundance) of a vitamin, mineral, amino acid …or (nowadays I am sure they are including) gut bacteria and the gut bacterias’ preferred food (fermentable fibers).

                So, switch that gorse wine to sauerkraut and organic veggie ferments, from your garden, if you can. Or do sauerkraut AND gorse wine…and send some across the pond to me…and I’ll return the favor with some awesome Jun culture kombucha!

                Rachel, I would really start studying the gut bacteria! Figure out exactly what foods bacteria like to eat and start eating it. Then research the heck out of specific gut bacteria and mental health connections. Get the right bacteria in and feed them everyday with a large variety of foods rich in fermentable fiber.

                I just finished off my 1st single – strain 24-hour yogurt: B. bifidus – and started my 2nd single-strain with B. infantis (this creates serotonin in the gut). Apparently, yogurt is an ideal carrier to get the Bifidos into your colon, alive (as is dark chocolate!-how essential a factoid is that?!) Bifidos also use yogurt (milk sugars) or dark chocolate as a food source: two fer one.

                …in all fairness I should also mention that the Bifidos like to eat raw onions, garlic, leeks and Jerusulem artichokes (inulin) as well as GOS (you can get this in GB: Bimuno.)

                I am noticing a brightening of my mood with the B. infantis yogurt, with only 2 days’ use. This is shockingly incredible! The power to alter mood issues for the positive is in our hands! …well, in our guts, that is. BTW, I used Natren’s bifido strains with great fermenting success. Try it.

                The regional conference you organized sounds awesome! Wish I could have attended! Sounds like you’re into a peer-advocacy model? Empowering people with disabilities…

                Hey, Rachel, post when you’ve got an update, I’ll watch out. So glad I could be an inspiration … just be sure to pass this knowledge on to others with mental illness.

                We are actively creating the next gen answer to depression and anxiety: food, bacteria, ferments, knowledge …and a warrior’s thriving immune system!
                Laura

    • Laura, About your number 6 and 7 – feeding the gut microbes with fermentable and the dangers of VLC diets…..I agree theoretically but for people with SIBO and possibly other gut problems for digesting fiber, it’s tricky. I think GAPS and SCD protocols can be very important for healing the gut BEFORE adding back in fermentable fibers. I don’t claim to have figured that out yet for myself but am working on it. It’s the conundrum of those type of illnesses. Needing the fiber to feed the healthy gut microbes but needing to avoid the fiber that can’t yet be digested properly or which feeds the pathogenic microbes. I resonate with what Kharrazian says about needing to fix gut motility and a lax IC valve before being successful in treating SIBO. What are your thoughts on when to add fermentable fiber when dealing with SIBO or similar gut issues?

      • Angela,

        I did GAPS for 1 1/2 years. Then I discovered the fermentable fiber / resistant starch / feed & seed your bacteria explosion of info on the net. Now that I understand about fermentable fiber and reseeding your gut, I realize that I was on GAPS for too long. I was starving my gut bacteria! I needed way more fermentable fibers! However, GAPS did offer me gut healing. But it also kept constipation going. So I experienced a dilemma.

        There is merit to the idea that the *process* of reseeding your gut can help with the removal of bacteria that are in the wrong place (i.e. overgrowth in the small intestine, SIBO). People are claiming that using resistant starch, for example, will pull bacteria out of the small intestines; they hitch a ride on the RS (raw, organic, unmodified potato starch or cooked/cooled potatoes or green bananas or green plantains, etc.) and leave the SI forever: no antibiotics needed. Also, there is merit to using bacteria (i.e. LABs and Bifidos) to reseed the colon so as to create an acidic environment, which will kill off pathogens, which die in an acidic environment. Eating sauerkraut every single meal could go a long way towards creating that acidic colon!

        I view this as a gardener would in rehabbing a plot, organically. Be methodical, test your soil, add amendments, see what happens, add / develop more compost and develop humus. Succession plant with the aim to, for example, initially increase nitrogen in year one. Plant plants next to each other that are complementary. Guard and protect your soil from the likes of death creators like round-up. Seek balance in your soil, encourage bacterial growth, don’t mine your soil, and the plants can’t help but prosper.

        I didn’t have very bad (obvious) digestive issues, as many do. What I do have are brain / mood issues. I have great sympathy for people whose guts are so out of balance that they react to, say, a raw carrot or a bite of kraut. So it might be that judicious use of bacteria (and their foods) could aid in the gut healing process, along with a simple diet that has totally non-inflammatory foods so there are fewer confounding variables.

        Simple diet with real foods and start throwing in bacteria and fermentable fibers, at low doses and slow. Journal results; discover what is working and what isn’t. If your symptoms get worse, dial back on strategies and go slower.

        Personally, knowing what I know now, I would have jumped in with both feet on a diet like Chris Kresser’s plus fermenting: ferments every meal, pre-digested by bacteria, so they’re easy on my gut, full of many more vitamins than the unfermented veggie AND full of good bacteria AND their food. Mouthful by mouthful get the bacteria down there doing my work for me. As it is supposed to be!

        It is sobering to realize that my iwhole body’s immune system is inextricably linked to the layers of bacteria in my gut. Inextricably… If there are no layers of bacteria there is no immune system… I never knew this before.

        Laura

  5. What do you do when you suffer from both anxiety and depression, but are allergic to milk, not just lactose intolerant? Do they make a probiotic from goats milk? I can tolerate that.
    Beverly

    • Hi Beverly,

      There are a number of wonderful probiotic sources that can be well tolerated by people who are allergic to dairy. For example, you can try eating sauerkraut or other lacto-fermented vegetables. You can also take a probiotic supplement such as Prescript Assist (http://store.chriskresser.com/products/prescript-assist-probiotic).
      Alternatively, if you can tolerate goat dairy, you can try making homemade yogurt or kefir from goat milk.

      • You can even get goat-milk yogurt commercially if you are not adept at making your own. Trader Joe’s carries a goat-milk yogurt that is the most delicious yogurt I’ve ever had from a ready-made source. And other health-oriented stores have it as well.

      • One could also try making SCD yogurt, using cow’s milk or goat-milk, and see if that is tolerated. Such is lactose free removing that as a potential sensitivity issue, but it does still contain casein. To minimize casein intolerance: one can try using A2 casein cow’s milk (this is from Jersey cows – this casein is thought to be better tolerated by some), or goat’s milk.

    • I am hearing all this talk about dairy yogurt. I make my own probiotic keifer coconut yogurt..

  6. I think there might be an error in the article. The abstract says that it is an inverse relationship between faecalibacterium and depression symptoms.

    • oops sorry, i see that new comments actually show in the top of the thread, not the bottom. my apologie for duplicate entries.

    • Erik,

      Thank you so much for catching that mistake! You are absolutely correct that it is a lower relative abundance of Faecalibacterium that is associated with more severe depressive symptoms. Thank you, I’ve made the correction and updated the article.

  7. I had an infection event which ended up being Lyme disease. I took a battery of antibiotics in the hopes of getting back to normal. I ended up with a host of new symptoms including allergies and severe anxiety at times. All new things.

    I found that taking fiber seemed to fix some of my allergy symptoms and, over time, the fiber along with extreme dietary modification relieved my anxiety. It’s all very experiential as opposed to clinical but I feel bad for those individuals suffering symptoms, like mine, and who haven’t made any of these connections. Thanks for the article.

  8. From the abstract of reference 8 we read: “Most notably, the MDD groups had increased levels of Enterobacteriaceae and Alistipes but reduced levels of Faecalibacterium. A negative correlation was observed between Faecalibacterium and the severity of depressive symptoms” which is the opposite of what is stated in the above article.

    • I pointed this out in a comment below as well. Could either Chris or Amy provide any clarity on this point?

    • Hi Marvin,

      You are correct, and I appreciate you catching that mistake! I’ve updated the article accordingly, and apologize for the confusion. It is a lower relative abundance of Faecalibacterium that is associated with more severe depressive symptoms.

  9. I am 43 yrs old. I suffered from some anxiety/depression off an on for several years. I have always eaten pretty well and exercised off and on but I started taking probiotics and some other vitamins about 2 years ago and I swear they have cured me. I have not had any bouts with either anxiety or depression. The vitamins I take are a multi vitamin, vitamin D and a Stressed out vitamin by Vitalogic. I will never stop taking any of these as they have made a huge difference.

    • Hi Jennifer,

      Thank you for sharing your positive experience with probiotics and specific supplements — it’s always great to hear to success stories!

  10. To those who haven’t an idea what to use:
    There are scads of different ones.
    I’ve tried various yogurts: To date, have found readily available: Mountain High and Nancy’s, full-fat, Plain, have decent probiotics for those who don’t have serious health impairments, and these are usually available at most mainstream groceries in the Western States, as far as I’ve found so far [CA,OR,WA,AZ,NV,ID], for instance. There may be others with a good handful of live biotics in their brands, too.
    Kefir: . is good stuff, usually far too much sugar to be useful, unless you get plain. . .Kombucha is a great way to start, and can get that with chia seeds in it, for Omega 3’s and a bit of protein, and Fiber.
    For capsules: Mt. Capra has Caprabiotics Advanced, which is somewhat room-temp stable [I keep in refrigerated anyway]. This is local in WA, but may be found online, too. . . Garden Of Life has Multivits with Probiotics in them. Garden of Life is widely available online and in stores. There are many companies that make very good probiotics, like Klaire Labs, Metagenics [though they don’t have broad-spectrums in their products yet, I think?], etc.
    NOTES from my experience and knowledge:
    LOOK FOR: ones with the Most Varieties of Cultures and the Highest Counts, because by the time they get to you, the counts will be lower.
    IF you have anxiety and depression, find ones that have L. Rhamnosus. . . .Consider your personal situation: Acidophilus helps tighten up loose stools; Bifidus/Bifidobacteria helps loosen stools.
    ALWAYS store them in the refrigerator!
    IF you have health issues, take more, daily. I usually use 2 per day, but if sicker, use two twice a day, or more, depending on how sick. . . .IF you are the average person, can take the average label amount, usually on empty stomach.
    IF you must use antibiotics, fit your Probiotics into that schedule at least 2 hours away from, and on an empty stomach, the antibiotics.
    The sicker someone is, the more they usually need more Probiotics, is a rule of thumb.

    • I must include: I am NOT prescribing. Merely sharing information based on my knowledge and experience.
      Please use your own best information and be a responsible, accountable best advocate for yourself! Most Docs do not have a clue about these things; I am thankful for Docs like Chris , who do, and have guts to speak Truth to Power. Its up to individuals to learn as much as they can, and make their best, informed choices.
      IF what YOUR Doc tells you, conflicts with information here, or that you’ve learned elsewhere, it’s up to YOU to find the tie-breaker information in order to make your own best informed choices.

  11. I started taking probiotics to help me cope with my PTSD but broke out in eczema all over my body. Does anyone have any other suggestions?

    • Try Eye Movement Desensitization Reprocessing (EMDR) for PTSD it worked amazingly well for me…https://www.youtube.com/watch?v=lsQbzfW9txc.
      not sure about the eczema with the probiotics, maybe try another brand. also sometimes symptoms get worse at the start due to die-off of bad bacteria.
      Research on the internet.. don’t give up on the probiotics as everyone needs them.. and gut health is the key to good health

    • Try Jarrow’s Ideal Bowel Support which is a form of Lac. plantarum. It takes a couple weeks to see results but many people heal their skin issues on this probiotic.

  12. -Amy’s Article says:
    “… A HIGHER relative abundance of FAECALIBACTERIUM was associated with MORE SEVERE DEPRESSION.”

    -The actual research article reads and displays (in charts):
    “Most notably, the MDD (Major Depressive Disorder) groups had increased levels of Enterobacteriaceae and Alistipes but REDUCED LEVELS of FAECALIBACTERIUM. A negative correlation was observed between Faecalibacterium and the severity of depressive symptoms.”

    So there’s a conflict in article and research ?
    HIGH FAECALIBACTERIUM = MDD
    REDUCED FAECALIBACTERIUM = MDD

    – Have you noticed any improvements in your mood by adding prebiotics or probiotics to your routine?
    Yes, by consuming more INULIN–food sources and Metamucil–(the kind not generally found in the USA), MUCH more resilient to stress, and energetic in general. It’s been the magic bullet for me (specifically) for moving through the general stress of life–quickly. And many many of the little things that might have bothered me previously, now seem irrelevant.
    *** Consuming INULIN INCREASES FAECALIBACTERIUM prausnitzii (Pubmed article 18590586)

  13. Hi Amy,
    I’m hoping you can give me some advice.. I just tested positive for h. pylori infection yesterday, so my GI doctor prescribed a 10-day course of antibiotics and a PPI. Along with all the awful GI symptoms, I’ve also been depressed, irritable and fatigued.(I’ve had symptoms for 3 wks; I’m a 29 year old female) Should I be following a certain diet while undergoing treatment, or post-antiobiotic treatment in order to eradicate the h. pylori and keep it from coming back? I’ve read about various views/studies on this, but am overwhelmed with conflicting information. Is there any evidence that the FODMAPS diet is beneficial in eradicating the h. pylori bacteria? Also would you suggest taking a probiotic while undergoing this triple therapy of antibiotics? I would appreciate any advice! Thank you.

    • Hi Nina,

      I agree there is a lot of conflicting information out there! At this time I’m not familiar with any research specifically looking at the role of FODMAPs in treating H. pylori. But some research does suggest there may be value in eating a lower carbohydrate diet and keeping blood glucose under control.
      Here’s one article that found a correlation between carbohydrate intake and H. pylori infection:
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275652/

      This article suggests that H. pylori growth may be promoted in higher glucose environments:
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196111/

      Please note that I generally do not recommend a low carbohydrate diet for a number of reasons (especially for women due to the potential for hormonal imbalances), but it may be a reasonable therapeutic approach to help treat the H. pylori.

      There is also a fair amount of research suggesting that a diet high in vegetables can also support treatment/prevention of H. pylori. Here’s a review article published last month, “Dietary amelioration of Helicobacter infection.”
      http://www.ncbi.nlm.nih.gov/pubmed/25799054

      And yes, taking probiotics both while taking the antibiotic treatment and continuing after completion of treatment can be a great option to help support gut health and rebuild a healthy microbiome. As noted in another reply, you might want to consider a combination of different probiotics for more intensive support, such as Prescript Assist, FloraMyces and MegaSporeBiotic. And, once you’ve completed the antibiotics, you may consider adding prebiotic supplements like FOS, inulin, or Prebiogen (http://store.chriskresser.com/products/prebiogen).

      If your symptoms continue after antibiotic treatment and some time spent rebuilding a healthy gut, then you may want to consider additional gut testing such as a SIBO breath test, stool test and urine organic acids test to look for additional gut microbial imbalances.

      Hope this information helps!!

  14. I would love more information on what to DO to create a healthy gut. Which supplements? How much? Which probiotics? When? I find this article informative but not practically helpful.

    • There are a number of options to help support a healthy gut, and since I didn’t want this article to be too long, hopefully some of our prior blog posts and other resources on this site can help!

      For prebiotics, you may consider adding resistant starch (RS) to your diet, whether through food or supplements such as potato starch. To read more about how RS supports a healthy microbiome, and some specific suggestions for increasing RS, please check out my prior post: http://chriskresser.com/how-resistant-starch-will-help-to-make-you-healthier-and-thinner/

      You can also choose to supplement with prebiotics such as inulin, FOS or arabinogalactan for more intensive support. This approach can be good after a course of antibiotics or food poisoning when you may need the extra boost, but is not generally necessary in the long term if you eat a nutrient dense diet with a lot of vegetables — and, the more variety, the better.

      Another great resource is Chris’s e-book on gut health:
      http://my.chriskresser.com/ebook/gut-health/

      For specific probiotic recommendations, you may need to experiment to figure out which probiotics work best for you. A few of my favorites:
      Prescript Assist (http://store.chriskresser.com/products/prescript-assist-probiotic)
      FloraMyces (or another brand of Saccharomyces boulardii)
      MegaSporeBiotic (can only be ordered though a healthcare practitioner, but excellent probiotic)
      Primal Defense Ultra

      Hope these suggestions help!

  15. Is there an error in the article?

    From the abstract…

    “A negative correlation was observed between Faecalibacterium and the severity of depressive symptoms.”

    From the article…

    “A higher relative abundance of Faecalibacterium was associated with more severe depression.”

    • Hi Erik,

      Yes, I did make an error, and I appreciate you catching it! You are absolutely correct that it is a lower relative abundance of Faecalibacterium that is associated with more severe depressive symptoms. Thank you, I’ve made the correction and updated the article.

  16. As the gut goes, so go our lives. If the flora is in good supply and balance, the entire body/mind health is affected in beneficial ways. When the gut biome is poorly supplied, the body deteriorates rapidly. When mineral deficiencies [the main ones AND all the trace ones!] also exist [as most people have], everything rapidly falls apart.
    Good Gut biome, and repletion of All Minerals [all the trace minerals too!], is critical to good health and healing of ailments.

    • +1 for minerals. Repleting my iodine levels was the key to my anxiety. I also take zinc and eat iron-rich red meat, or I get some minor symptoms of depression + some other physical symptoms.

      I actually didn’t end up taking any pre- or probiotics, because the iodine improved my gut function a lot. Though I do eat a lot of prebiotic fiber in my food now, since I can finally tolerate it.

  17. Even these heinous atrocities can become more easily handled, and feelings of stress reduced, if one can get enough daily probiotics and broad-spectrum minerals, at the very least…that’s what we’ve found. We use other practices as well, to help us place our frame of mind/perspectives, in a better place. Doing these, helps measurably, compared to when we don’t do them.

  18. Spot on.

    I’ve written quite a bit on the topic after doing much reading/research, and am about to get the uBiome microbiota test kit to get an idea of how healthy is my own microbiome.

    This has become a hot spot for scientific inquiry, and it seems that each week another significant finding is announced about yet another health condition is influenced by those 100 trillion critters in and on us.

    I encourage readers to eat fibrous and fermented foods, and to supplement with prebiotics (like inulin) and probiotics (youghurt or good supplement). Doing this will help ensure that the beneficial bacteria thrive and dominate those that will do us harm.

    More suggestions here: http://bit.ly/1beVRl5

  19. I do believe that our gut flora (along with adequate pre- and probiotics from our diet) is critical for overall wellbeing. I am caring for a child for whom a cecostomy is being recommended. This young child already struggles with anxiety and depression. I am very worried about how daily cecostomy flushes (with saline or similar) will affect the flora biofilm in the colon – but my concern is being dismissed by allopathic GI docs. Anyone know of research that could help me weigh the pros and cons? (I can read research-jargon.) Or other thoughts? Thx.