Dr Dingle's Blog / mental health
Nutritional deficiencies are now a recognized risk factor for psychiatric disorders, while excessive intake of nutrient poor foods is predictive of poor mental health, while a healthy diet reduces risk.
For example studies have shown low blood levels of certain nutrients in psychiatric disorders, folate (B9) and B12 are often deficient in schizophrenia, and are associated with symptom severity. That is the lower the levels the higher the symptoms. While on the other side supplementing with B-vitamins can significantly reduce symptoms of schizophrenia and reverse some of the conditions associated with the disorder.
Antioxidant vitamins like C and E are also lower in long-term schizophrenia patients, potentially contributing to the elevated oxidative stress and inflammation observed in this population. While vitamin D is involved in the onset of schizophrenia and is associated with worsened physical and mental health outcomes the lower it goes. Zinc and selenium, are also low in people with schizophrenia and depression.
By making small positive changes in our eating we can achieve vast improvements in our mental health.By eating healthy, nourishing foods we are supplying our brain with the nutrients it needs to make neurotransmitters, ensuring brain cells function at their optimal levels. When neurotransmitters are out of balance, it is easy for us to feel anxious, stressed, depressed and uninterested. For example, if dopamine, the ‘feel good’ neurotransmitter, levels in the brain fall below the desired level, an individual’s capacity to feel happy, excited, or motivated, becomes limited also.
We can take measures to prevent against such mood states by ensuring we consume foods with adequate nutrients to ensure the desired level of neurotransmitters are maintained.
Just as important a large body of evidence shows the role of feeding the gut microbiome can have a dig impact on our mental health and mental health states. But more on that later
In today’s busy and hectic society many see sleep as a luxury rather than what it is – a necessity. More and more people are working overtime, and shift work trying to juggle a busy family life around their work. Along with this, it is not unusual for both parents to be working full time. The advent of our 24/7 society has pushed regular sleep to the side. Because of this, many men and women (and even children) wrongly consider sleep a waste of time.
Sleep is an essential element of the human body, without it we cannot survive. Getting enough sleep is associated with energy, joy, optimistic thinking and coping with negative emotions. Despite this almost 90 percent of Australians suffer from some type sleep disorder at some stage of their lives. Of these, 30 percent suffer from severe sleep disorders. Very few people regularly enjoy the amount or quality of sleep that they need. The estimated economic costs to the country from this are between $3 billion and $7 billion annually. There are also huge, unmeasured physical, psychological, emotional and social costs.
Sleep is complicated in the way that there are many different factors that influence the effectiveness of sleep. It’s not just duration that determines the effectiveness of said sleep, factors such as quality, frame of mind and deepness all contribute to the maximum desired outcome and even our perception of how we sleep. Many factors can play a part in the quality and quantity of our sleep and to maximise our sleep time an understanding of this is essential.
On average a healthy person will spend around one third of their life sleeping (Duman et al, 2009). Sleep is considered a natural periodic state of rest for the mind and body, in which the eyes will usually close and consciousness is completely or partially lost resulting in a decrease in bodily movements and responsiveness to external stimuli (Blanch et al, 2009). Inadequate hours of good quality sleep leads to a disruption to vital biological processes resulting in a decrease in cognitive function mental and physical health (Anderson et al, 2009) including impaired work performance due to a decrease in attention, judgement and responsible decision making (Volkow, 2009).
Why we sleep
Mammals are naturally diurnal animals and sleep for humans are broken into two distinct phases. These phases, Non Rapid Eye Movement (NREM) and Rapid Eye Movement (REM), represent the depth of sleep and electrical activity in the central nervous system (CNS) (Cirelli & Tononi, 2008). However, sleep is a heightened anabolic state where rejuvenation of many organ systems occurs, especially the immune and nervous systems. NREM is further broken into phases one to three during which have different waves of sleep and cognitive perceptions, phase one for example is associated with hyper‑CNS responses. During this phase the body may quickly jerk out of steep and this will be felt as a falling sensation (Walsh, 2009). Various genetic mutations have been associated with sleep including DEC2 mutations that lower the sleep requirement from eight hours to six and the 600072 prion gene that predisposes to Fatal Familial Insomnia (Kniff in, 2009; McKusick and Kniffin, 2009). The natural circadian rhythms of the body are a result of variations in levels of circulating melatonin hormone, from the pineal gland, and also adenosine levels which increase over the course of the day (Imeri & Opp, 2009).
Among the theories on why humans sleep, scientists have proposed the following:
Sleep may be a way of recharging the brain. The brain has a chance to shut down and repair neurons and to exercise important neuronal connections that might otherwise deteriorate due to lack of activity or over activity.
Sleep gives the brain an opportunity to reorganize data to help find a solution to problem, process newly learned information and organize and archive memories.
Sleep lowers a person’s metabolic rate and energy consumption.
The cardiovascular system also gets a break during sleep. People with normal or high blood pressure experience a 20 to 30% reduction in blood pressure and 10 to 20% reduction in heart rate.
During sleep, the body has a chance to replace chemicals and repair muscles, other tissues and aging or dead cells.
In children and young adults, growth hormones are released during deep sleep (World Federation of Sleep Research and Sleep Medicine Societies
Immune function is highest when we sleep
Detoxing. There appear to be “hidden caves” inside the brain, which open up during sleep, allowing cerebrospinal fluid (CSF) to flush out potential neurotoxins, like β-amyloid, which has been associated with Alzheimer’s disease. The research discovered “hidden caves” inside the brain, which open up during sleep, allowing cerebrospinal fluid (CSF) to flush out potential neurotoxins, like β-amyloid, which has been associated with Alzheimer’s disease. The interstitial spaces in the mouse’s brain took up only 14% of the brain’s volume while it was awake. Yet, while it slept, this increased by almost two-thirds to take up fully 23% of the brain’s total volume. The effect is that potential neurotoxins, like β-amyloid, are cleared twice as fast during sleep as during waking. While many neurological diseases, like strokes and dementia, are associated with problems sleeping. It could be that lack of sleep, and restriction of the brain’s cleaning system, may cause toxic metabolites to building up, leading to long-term damage.
Most likely we sleep for a combination of these reasons
Part 2 and more coming
Obvious symptoms of sleep deprivation constant yawning and the tendency to doze off when not active for a while; for example, when watching television, Grogginess when waking in the morning Sleepy grogginess experienced all day long (sleep inertia) Poor concentration and mood changes (more irritable).
Some of the physical effects found from long term fatigue are heart disease, diabetes, high blood pressure, gastrointestinal disorders and depression (Workplace health and safety QLD, 2008). A study conducted by Andersen involving rats also showed sleep deprivation affects the expression of genes related to metabolic processes, response to stimulus and signalling pathways (Andersen et al, 2009).
Numerous studies have shown that even a little bit of sleep deprivation decreases efficiency and increases risk of disease, including cardiovascular disease, cancer and diabetes. Sleep deprivation has been shown to negatively affect endocrine (hormones) and metabolic functioning as well as nervous system balance (Nilsson, et al., 2004). Sleep deprivation is associated with an increased concentration of cortisol plus other indicators of increased stress such as elevations in pulse rate, body temperature and adrenaline secretion (Vgontzas, et al.,1999). Sleep deprivation also appears to increase blood concentrations of certain chemicals called cytokines and C-reactive proteins (Irwine, 2001 and Vgontzas, et al., 1998), indicating an inflammatory reaction. The effect of unremitting low-grade inflammation may be to damage the inner walls of the arteries, which sometimes leads to vessel narrowing, high blood pressure, stroke, and heart disease (Irwine, 2001). During truncated sleep, your heart might have to work harder, constricting blood vessels and increasing blood pressure even more, which could conceivably result in a heart attack or stroke (Martins, 2003).
Sleep is as important to the human body as food and water, but most of us don’t get enough sleep. Insufficient sleep or disruptions to the sleep contribute to adverse health effects. Numerous studies have also shown that even a little bit of sleep deprivation decreases efficiency and increases risk of disease, including cardiovascular disease.
Initial changes to cardiovascular system from insomnia include hypertension, which is a potent co‑morbidity for other cardiovascular diseases. Hypertension has been linked to reduced sleep duration, with the highest correlation shown under 6 hours sleep per night (Gottlieb et al. 2006). However, associations have also been made between sleep of over 9 hours per night and hypertension and obesity. Furthermore this has not been supported at all in some studies and PPI in one older North American population actually showed a reduced risk of hypertension (Phillips, BOková and Enrigh, 2009.).
A study of 71,617 female health professionals found that sleeping fewer than five hours per night was associated with a 39 percent increase in the risk of coronary heart disease; even six hours per night showed an increase of 18 percent compared to sleeping eight hours per night (Najib, et al., 2003). In an analysis of data on more than one million people, the levels of nearly all forms of death were two-and-a-half times higher for people who slept four hours or less compared to those who slept between seven and eight hours on average
A study of 71,617 female health professionals found that sleeping fewer than five hours per night was associated with a 39 percent increase in the risk of coronary heart disease; even six hours per night showed an increase of 18 percent compared to sleeping eight hours per night. In an analysis of data on more than one million people, the levels of nearly all forms of death were two-and-a-half times higher for people who slept four hours or less compared to those who slept between seven and eight hours on average
Experimentally, sleep deprivation has been shown to negatively affect glucose metabolism and to enhance factors associated with Type 2 diabetes (Nilsson, et al., 2004). Research has also shown that people who experience sleep disorders were as much as three times as likely to develop Type 2 diabetes (Kawakami, 2004). Subjects in one study demonstrated impaired glucose tolerance for ten days after four hours of sleep deprivation (Spiegel, et al.,1999). It is also found that sleep deprivation can play a role in obesity. Sleep deficits bring about physiologic changes in the hormonal signals that promote hunger and, perhaps thereby, obesity (Spiegel, et al., 2004). One study found that after two days of sleep curtailment the subjects had reduced levels of the fat-derived hormone leptin and increased levels of the stomach-derived hormone ghrelin. These hormones are responsible for regulating hunger and appetite (Spiegel, et al., 2004). These hormonal differences are likely to increase appetite, which could help explain the relative high BMI in short sleepers.
Part 5 and more coming
Not only are probiotics considered beneficial to digestive health, and immune health but increasing evidence suggests direct and indirect interactions between gut microbiota (GM) and the central nervous system (CNS).
A large body of research has supported the presence of a pathway of communication between the gut and the brain, modulated by the gut microbiota, giving rise to the term “microbiota-gut-brain” axis. It is now thought that, through this pathway, microbiota can affect behaviour and modulate brain plasticity and cognitive function. In particular, studies have illustrated an association between the gut microbiota composition and cognitive processes such as learning and memory. Research has shown that the intestinal microbiota additionally contribute to the early development of normal social and cognitive behaviours 1. While probiotic and prebiotic supplementation can have a positive effect on mood and psychological symptoms such as depression and anxiety, stress as well as mental health issues including depression, Alzheimers and Parkinson’s diseases. This new area of research, called “psychobiotics” is where the beneficial bacteria (probiotics) or prebiotics that influence bacteria–brain relationships can exert positive emotional, cognitive, systemic, and neural benefits 2. This process is thought to occur primarily through the central nervous system (CNS) as well as through metabolic, hormonal and immune pathways.
Recent evidence indicates a clear association between changes in the microbiota and cognitive behaviors and there is increasing evidence on the effects of supplementing with probiotics on improving cognitive disorders 3. One of the earliest studies found that the wrong type of bacteria added to the gut of germ free animals (containing no microbiota), can cause stress related negative behavious while administration of probiotics can improve cognitive behaviors including learning and memory 1.
In a clinical trial conducted among 60 Alzheimer's patients where the probiotic supplemented group took 200 ml/day probiotic milk for 12 weeks, the probiotic group showed a significant improvement in the MMSE (Mini-mental state examination) which is a measure of cognitive function. In addition, they reported lower levels of oxidation and inflammation, blood fats (tryglicerides) and improved insulin resistance and Beta cell (pancreas) function which controls and stores insulin in the probiotic group compared to the control group 4. A pretty good reason to supplement with probiotics.
Growing research also shows probiotic supplements may be used therapeutically to modify stress responses and symptoms of anxiety and depression 5,6,7,8. One study found that a short 3-week intervention with probiotics-containing milk drink improved mood scores compared to participants who received a placebo. Although, improvement in mood was only observed for participants who showed elevated symptoms of depression at the beginning 9. A second study found that a month of probiotic supplementation significantly improved depression and anger 10. In a triple-blind study of 20 healthy participants without a current mood disorder over 4 weeks, probiotics significantly reduced negative thoughts associated with a sad mood compared to placebo. The positive effect was mostly because of reduced rumination and aggressive thoughts 11. While a study of people with chronic fatigue syndrome found that supplementing with probiotics for 2 months significantly reduced their anxiety scores 12.
Similar results have also been shown in animal studies. In a study of healthy mice researchers observed a reduction in anxious and depressive behavior after feeding healthy mice with probiotics 13. A similar result was shown in adult rats with a reduction in depressive-like behaviors after feeding them with Bifidobacterium species. The effect was comparable to the effects of administering the antidepressant citalopram 14.
Stress and anxiety disorders are two of the most common psychiatric illnesses worldwide, affecting both children and adults. Increasing numbers of studies have suggested that the gut microbiota is involved in the pathophysiology of stress-related disorders. For example, a number of studies have now shown that certain strains of bacteria increase anxious behaviour while others reduce it. One study found that participants who were given a mixture of probiotics containing Lactobacillus and Bifidobacterium species showed significantly less psychological distress than matched controls 15. A recent (November 2016) meta-analysis of seven studies with around 300 participants showed that supplementation with probiotics resulted in a significant improvement in psychological symptoms of depression, anxiety, and perceived stress in healthy human volunteers 16.
However, probiotics and the effects on our moods appears to be a two way street. While the gut microbiome can alter moods, our moods can also alter our gut microbiome. Chronic stress can cause behavioral, cognitive, biochemical, and gut microbiota aberrations. In a study of 1002 cases and controls followed up for 12 years, those with gut disorders had elevated levels of anxiety and depression at baseline, but also those with higher levels of anxiety and depression were more likely to have gut disorders at follow-up 17.
Animal studies have also shown certain strains of Lactobacillus exert a positive effect on anxiety-related behavior and responses to stress 13,18. In a study on rats subjected to 21 days of stress the results showed that administration of probiotics improved the stress-induced behavioral (anxiety and depression) and cognitive dysfunction, showing an effect similar to and better than that of an antidepressant. It also resulted in lower stress hormones and improved blood parameters suggesting it was dealing with some of the underlying mechanisms 18.
Other studies have noted that microbiota have an important influence on the development of cognitive processes in young mice 1. Depletion of a normal gut microbiome in early life, especially during the post-weaning period, may affect cognitive and social behaviours in the brain through the alteration of neuropeptides (chemical messengers) such as vasopressin and oxytocin 19,20. In fact, the research suggests a strong role of the gut microbiota in autism spectrum disorder. Interestingly, treatment of mice with autism with probiotics has shown to ameliorate autism related traits 21. In another twist on this, a study of 75 pregnant women given probiotics 4 weeks before their due dates and then continued giving the probiotics to the infants, or to the mothers if they were breastfeeding for 6 months did not develop any ADHD or Asperger’s after being followed for 13 years. 17.1% of the children in the placebo group developed ADHD or Asperger’s. Not one child in the probiotic group did 22.
Importantly, studies have shown that multispecies probiotics (i.e., combining different strains of specific genera) can have increased effectiveness through an additive effect of specific strain properties such as colonization of different niches, enhanced adhesion and induction of an optimal pH range, as compared to mono-species supplements 23,24. So take a mixed species supplement for the best results.
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