Terri Hirning

The Role of Diet and the Gut in Mental Health

Terri Hirning

While the traditional mental health model focuses on brain function, neurotransmitters and potentially pharmaceutical medications, the ever burgeoning integrative mental health field understands there is more to it than that. Even mainstream media is starting to get the hint. Our gut influences our mind, emotions, cognition and mental health more than we've given it credit for in recent history. Whether we want to focus on the role food allergies play on mental health (1), (2) or how the gut-brain axis impacts our mental health (3), or even how the microbiome shapes our mental functioning (4) we can see the trend in research confirming what many integrative physicians and clinicians know: the gut matters

When we talk about the gut, we must cover diet. Some literature even suggests that a debilitating mental health disorder like Alzheimer's now be called "Type 3 Diabetes" (5) because of its links to certain kinds of foods and a generally poor diet. What is causing the alarming trend of food allergies, food sensitivities and the increase in auto-immune conditions? Is it GMO's? Is it Glyphosate (the herbicide used in products like Monsanto's Roundup)? Is it the prevalence of processed grains in our diets now? It may be all of thesethings, or none of these things, but as physicians and clinicians, the data suggests we take a closer look at our patients' diets and here are some things to consider:

Is there an underlying food allergy or multiple allergies? This can be an easy and yet very powerful place to start. Research shows that food allergies can indeed cause manifestations of mental health disorders. Running a simple IgG food allergy test from the Great Plains Laboratory, which also includes markers for Candida (harmful fungus in the gut) can be a great first step. More mainstream information on the treatment of Celiac disease can be also helpful in finding its connections to many mental health disorders like dementia, seizures, schizophrenia, etc.(6), and one does not have to be diagnosed with Celiac disease to be sensitive and reactive to gluten.

What about healthy gut function and microbiome population? Our microbiome is sensitive to our diets, and quickly reactive to changes. Looking at potential gut dysbiosis and the levels of beneficial flora in the gut is very important. An organic acids test will show you a wide range of metabolic markers, including several for bacteria (like Clostridia) and fungus (like Candida albicans) in the gut. If a patient has high levels of these, a course of treatment can be started to rid them of these invaders, possibly including dietary restrictions (like a low sugar, low carb diet) and adding helpful antibacterial or antifungal supplements. Then, to assess the beneficial bacteria in the gut, you may want to run a comprehensive stool analysis. This will help determine whether a patient needs to add a high-quality probiotic supplement to their diet and possibly increase his/her intake of probiotic-rich and fermented foods like kefir and sauerkraut.

Today's mental health disorders are very complex. Their treatment requires a well-rounded look at the many factors impacting the body and brain, including diet, lifestyle, the microbiome, and more. When an integrative approach is used and these many factors considered when creating a treatment plan, time and time again we see improvements in functioning and a reduction in clinical symptoms.

Clinical References:

  • Jackson J1, Eaton W2, Cascella N3, Fasano A4, Santora D5, Sullivan K6, Feldman S6, Raley H7, McMahon RP6, Carpenter WT Jr6, Demyanovich H6, Kelly DL8.Gluten sensitivity and relationship to psychiatric symptoms in people with schizophrenia Schizophr Res. (2014) Oct 10. pii: S0920-9964(14)00511-8. doi: 10.1016/j.schres.2014.09.023.
  • Genuis SJ1, Lobo RA2. Gluten sensitivity presenting as a neuropsychiatric disorder . Gastroenterol Res Pract. (2014);2014:293206. doi: 10.1155/2014/293206.
  • Nemani K1, Hosseini Ghomi R2, McCormick B3, Fan X3. Schizophrenia and the gut-brain axis. Prog Neuropsychopharmacol Biol Psychiatry. (2014) Sep 19;56C:155-160. doi: 10.1016/j.pnpbp.2014.08.018.
  • Severance EG1, Yolken RH2, Eaton WW3. Autoimmune diseases, gastrointestinal disorders and the microbiome in schizophrenia: more than a gut feeling. Schizophr Res. (2014) Jul 14. pii: S0920-9964(14)00319-3. doi: 10.1016/j.schres.2014.06.027.
  • De la Monte S, Wands J. Alzheimer's Disease Is Type 3 Diabetes–Evidence Reviewed. J Diabetes Sci Technol. (2008) 2(6): 1101–1113.
  • Velasquez-Manoff Moises (2014 October 12). Can Celiac Disease Affect the Brain? The New York Times. Retrieved from:http://www.nytimes.com/2014/10/12/opinion/sunday/can-celiac-disease-affect-the-brain.html?smid=tw-share&_r=0

The Role of Vitamins, Antioxidants, and Anti-Inflammatories in Breast Cancer Prevention and Treatment

Terri Hirning

October is Breast Cancer Awareness Month. As such, we would like to take a moment to focus on how nutritional and supplement therapy can play a role in the prevention and treatment of cancer. When we look at how antioxidants impact cancer, we can see that there is scientific documentation of reduced development of breast cancer in those with high dietary intake of antioxidants. One study in late 2014 titled The Rotterdam Study provides this information: "These results suggest that high overall dietary antioxidant capacity are associated with a lower risk of breast cancer."1 Women who had higher rates of antioxidant intake via diet were less likely to develop breast cancer. What about those who already had breast cancer? Could it help with treatment? A March 2014 issue of Anticancer Research featured a study showing the use of lycopene and beta-carotene in cell death of human breast cancer cell lines. "Our findings show the capacity of lycopene and beta-carotene to inhibit cell proliferation, arrest the cell cycle in different phases, and increase apoptosis."2 Vitamin C has also been studied in terms of its potential impact on breast cancer deaths and has been shown to have a positive effect on mortality rates. "Dietary vitamin C intake was also statistically significantly associated with a reduced risk of total mortality and breast cancer-specific mortality."3

If we can look at the data and determine that higher intake of antioxidants and nutrients can not only reduce development of breast cancer but can also positively impact the mortality rates of cancer, the question then becomes how do we encourage our patients and clients to incorporate these into their diets with higher frequency? We must educate them on the role antioxidants play and the resources available to obtain them, whether from foods or supplements. For example, lycopene is a nutrient that is highlighted for its anticancer properties, specifically in reference to breast cancer. Lycopene is a carotenoid that gives many fruits and vegetables their red color. Unlike other carotenes, lycopene does not get converted into vitamin A. The top 10 sources of dietary lycopene are:

  • Guava
  • Watermelon
  • Tomatoes (cooked)
  • Papaya
  • Grapefruit
  • Sweet Red Peppers (cooked)
  • Asparagus (cooked)
  • Red (purple) cabbage
  • Mango
  • Carrots

Continued from BioMed Today:

Encouraging patients to incorporate more foods with lycopene, like those listed above, into their diets is one component. Supplements can also be suggested as a potential option. This is especially true in the case of vitamin D, for which there are many studies showing its role in the prevention of cancers. Adequate vitamin D is being revealed as a critical factor for preventing many diseases, including breast cancer, today.8 "Case-control studies and laboratory tests have consistently demonstrated that vitamin D plays an important role in the prevention of breast cancer."9 Unfortunately due to a variety of reasons, many people are deficient in vitamin D which then can then compromise optimal health. Testing for vitamin D levels, ideally twice a year, is a great way to monitor this critical nutrient and help your patients optimize their health and wellness. Supplementation can then also be recommended to optimize levels. Another promising resource for warding off disease and cancer is curcumin, the extract of the turmeric root. Because of its potent antioxidant and antimicrobial properties, it is being studied extensively for its potential in cancer treatment. The American Cancer Society's website has this to say about it: "Curcumin can kill cancer cells in laboratory dishes and also slows the growth of the surviving cells. Curcumin has been found to reduce development of several forms of cancer in lab animals and to shrink animal tumors."4 The typical therapeutic dose, between 3 and 10 grams per day, exceeds what is normally used in cooking and obtained through dietary consumption so a supplement would be most effective.

Could another reason for the efficacy of curcumin on cancer cell death be its potent anti-inflammatory properties? Curcumin has been studied widely for both its safety and anti-inflammatory potential.5,6 "The laboratory studies have identified a number of different molecules involved in inflammation that are inhibited by curcumin including phospholipase, lipooxygenase, cyclooxygenase 2, leukotrienes, thromboxane, prostaglandins, nitric oxide, collagenase, elastase, hyaluronidase, monocyte chemoattractant protein-1 (MCP-1), interferon-inducible protein, tumor necrosis factor (TNF), and interleukin-12 (IL-12)."7 We see science validating the role our lifestyle has in development of cancer. Diet, exercise, supplementation, our stress level, and other factors all contribute to the whether or not we develop disease and also to our ability to reverse it. It is important to find ways to offer a variety of prevention and treatment options that work with our patients' lifestyles.

Clinical References:

  • Pantavos A, Ruiter R, Feskens E, E deKeyser C, Hofman A, H Stricker B, H Franco O, C Kiefte-deJong J (2014). Total dietary antioxidant capacity, individual antioxidant intake and breast cancer risk: The rotterdam study, International Journal of Cancer. 2014 Oct 4. doi: 10.1002/ijc.29249. [Epub ahead of print]
  • Gloria NF, Soares N, Brand C, Oliveira FL, Borojevic R, Teodoro AJ (2014).Lycopene and beta-carotene induce cell-cycle arrest and apoptosis in human breast cancer cell lines, Anticancer Research. 2014 Mar;34(3):1377-86.
  • Harris HR, Orsini N, Wolk A (2014). Vitamin C and survival among women with breast cancer: a meta-analysis,European Journal ofCancer. 2014 May;50(7):1223-31. doi: 10.1016/j.ejca.2014.02.013. Epub 2014 Mar 7.
  • Turmeric (2012). Retrieved on October 5, 2014 from Link
  • Chainani-Wu NJ (2003). Safety and anti-inflammatory activity of curcumin: a component of tumeric (Curcuma longa), Journal of Alternative and Complementary Medicine. 2003 Feb; 9(1):161-8.
  • Jurenka, JS (2009). Anti-inflammatory Properties of Curcumin, a Major Constituent of Curcuma longa: A Review of Preclinical and Clinical Research, Alternative Medicine Review. Volume 14, Number 2, 2009.
  • Nita Chainani-Wu (2003). The Journal of Alternative and Complementary Medicine. February 2003, 9(1): 161-168. doi:10.1089/107555303321223035.
  • Vitamin D and Cancer Prevention (2013). Retrieved on October 5, 2014 from http://www.cancer.gov/cancertopics/factsheet/prevention/vitamin-D
  • Walentowicz-Sadłecka M, Sadłecki P, Walentowicz P, Grabiec M (2013). The role of vitamin D in the carcinogenesis of breast and ovarian cancer, Ginekologia Polska. 2013 Apr;84(4):305-8.

The SCD, GAPS, and Paleo Diets: How They Compare and How They May Help Your Patients

Terri Hirning

Special diets have become increasingly common and more popular in recent years. Reports from both physicians and patients, many with laboratory tests confirming, say they can be helpful for a variety of diseases including autism, ADHD, multiple sclerosis, auto-immunity, rheumatoid arthritis, bowel conditions, and many more. Three diets in particular appear to help address gut dysbiosis, the overgrowth of microbes such as yeast and bacteria, which can be problematic for many individuals. Research shows that more than 70% of children with an Autism Spectrum Disorder (ASD) report a history of GI complaints.1 "Leaky Gut", or intestinal permeability, results from larger than normal spaces between the cells of the gut wall. These spaces allow undigested food and toxins to enter the blood stream. When this happens, the immune system can mount an attack against the foreign particles which may result in food sensitivities and/or allergies. When the offending foods are eaten again, the release of antibodies triggers inflammation. This chronic inflammation further exacerbates the cycle by lowering Immunoglobulin A (IgA) levels. Adequate IgA levels are required to protect the intestinal tract from the gut pathogens such as clostridia and yeast. This continuous cycle can increase gut dysbiosis and negatively impact the overall health of your patients. All three of these special diets – SCD, GAPS, and Paleo may help address these issues by reducing the amount of undigested and allergenic foods being consumed and healing both the gut and brain.

Understanding how the SCD, GAPS, and Paleo diets may help the gut and brain, as well as the major differences between the three diets, can help you provide guidance to your patients when addressing food allergies, autoimmunity, and gut dysbiosis. All three diets share the basic foundations of reducing carbohydrates, avoiding grains (including those that are gluten-free) avoiding refined sugar, avoiding packaged/processed foods, focusing on nutrient-dense foods, and emphasizing the importance of eating a variety of vegetables. Each diet also has its own unique elements, and here is how they compare:

SCD – Specific Carbohydrate Diet:

  • This diet was pioneered by Dr. Sidney V. Haas.

  • Patients are encouraged to follow the program in the book Breaking the Vicious Cycle by Elaine Gottschall.

  • Carbohydrates allowed on this diet are classified by their molecular structure.

  • Allowed carbohydrates are monosaccharides and have a single molecule structure that allow them to be easily absorbed by the intestine wall.

  • Disaccharides (double molecules) and polysaccharides (chain molecules) are not allowed.

  • Some dried beans and legumes can be added in after symptoms resolve and in accordance with the soaking and preparing instructions from the book.

  • This diet does allow some dairy (fermented/cultured).

  • Results of a Rush University SCD study show the diet leads to better microbial gut diversity.2

  • This diet focuses on reduction of pathogenic organisms in the gut rather than introducing beneficial bacteria.

  • Website: http://www.breakingtheviciouscycle.info/home/

GAPS – Gut and Psychology Syndrome Diet:

  • Dr. Natasha Campbell-McBride expanded on the principles of GAPS in her book The Gut and Psychology Syndrome.

  • GAPS is very similar to SCD except for that it adds many probiotic-rich, cultured foods.These foods may help recolonize good bacteria and counteract bad bacteria.

  • This diet has more phases and may be seen as more rigorous than SCD.

  • GAPS emphasizes addressing brain health over gut health, but should certainly assist with both.

  • Website: http://www.gapsdiet.com

Paleo Diet:

  • This diet is based upon the concept that the optimal diet is the one to which we are genetically adapted. It recommends modern, everyday foods that mimic the food groups of our pre-agricultural, hunter-gatherer ancestors

  • Paelo allows some starches that the other diets do not allow.

  • It does not allow dairy products.

  • It does not allow legumes or beans.

  • This diet may be seen as the least restrictive of the three diets.

  • Website: http://thepaleodiet.com/

How to know when to suggest a diet like SCD, GAPS or Paleo for your patients: Have clinical tests like our Organic Acids Test or Microbial Organic Acids Test indicated yeast and/or bacterial overgrowth? Have repeated courses of antibiotics and/or antifungals failed to resolve these often chronic disorders? Have you tried multiple probiotics which have failed to repopulate the gut with good bacteria and yeast? Has IgG food allergy testing shown continued food allergies despite removal of the common allergens like wheat, dairy, and soy? Has your patient developed new or increasing food allergies despite being on an "allergy-friendly" diet? If you answered yes to any of these questions, considering a more specific and restrictive diet beyond GFCF (Gluten Free, Casein Free) could be the next step in healing for your patients.

Diet can be a very effective way to reduce harmful gut pathogens by removing their food supply and decreasing the inflammation they cause. Diligence, dedication, and strict adherence is required from your patients to see the full benefits of these special diets. In cases where antibiotics, antifungals, supplements, and probiotics have not been successful, these diets may help reverse the gut dysbiosis, after which reintegrating various supplements and probiotics may be effective . For newly diagnosed patients, implementing one of these diets may be a good way to begin their healing process quickly and effectively. As Ann Wigmore, health practitioner, nutritionist, and whole foods advocate said, "The food you eat can be either the safest and most powerful form of medicine or the slowest form of poison".

Clinical References