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Mind Body Medicine Sioux City

The Gut-Brain Connection

“I have a chemical imbalance and that’s why I am seeing you to find the right medication to get chemicals balanced in my brain.”

I often hear the above statement from patients who seek consultation with me for their mental health. In 1960s, psychiatry researchers developed the catecholamine or biogenic amino hypothesis of mood disorder, which led to the concept that an imbalance in neurotransmitters resulted in abnormal moods. This has become how media portrays mental health and treatment. While there is still a role for neurotransmitters, their role is to be understood in the context of the entire brain metabolism. The microbiome and inflammation (among other things like oxidative stress and  mitochrondrial function) all relate to understanding the brain metabolism mechanics. 

Our bodies are a highly complex ecosystem including 39 trillion bacteria, mostly good, inside and on our bodies’ surface. The majority of the bacteria within our bodies (known as the microbiome) work in complex ways to promote and maintain our health by interacting with cells and organs in various ways. Some gut bacteria have endocrine functions and make oxytocin, serotonin and dopamine. These chemicals activate certain signals in the brain and thus affect our mood (G. Clarke et al). Another example is the Lactobacillus plantarum that produces metabolites that stimulate an anti-inflammatory response by intestinal stem cells which would help with healing (A. F. Athiyyah et al.) . 

The microbiome starts at birth after passing through the birth canal, and is shaped  by breast milk first and then diet, environment and human contact throughout our lives. This is why I often ask my patients if they were delivered by cesarean section  and if they were breastfed or bottle fed. This is why it is also important to know if a patient had a gastric bypass as their microbiome has been changed following the surgery. 

A majority of the immune system is located in the gut. The immune  system decides which bacteria and foods are “safe and good”, and which ones need to be defended against by producing certain chemicals that cause inflammatory signals. These signals travel to the brain which can eventually lead to depression and other mental health problems.

Chronic inflammation does not give the body time to heal which results in continued damage to the internal lining of  the intestines. As a result, inflammatory signals and bacteria move to other parts of the body and negatively impact it. All this disturbs the microbiome (also known as gut dysbiosis) which in turn impacts the brain. This is why I ask patients what kind of food they eat, how they find they feel after eating certain foods and whether they tried to eliminate certain foods from their diet. 

Other causes for gut dysbiosis are broad spectrum antibiotic use, chronic stress, a poor diet and the modern environment being too clean. 

So, I tell my patients there is an increase amount of evidence that what we eat affects how we feel, and that every choice we make relative to our diet matters. Keeping a diet journal is a good start to gut and brain health recovery.  

References

The Emerging Field of Nutritional Mental Health: Inflammation, the Microbiome, Oxidative Stress, and Mitochondrial Function

Berk M, LJ Jacka, FN, Oneil A, Passo JA, Moylau S, Byrne ML 2013. So Depression isan Inflammation  Disease, But Where Does the Inflammation Come From? British. Medical Journal of Medicine

Eat to Beat Disease, William Li, MD

Gardner and Bolles. 2005. “Beyond the Serotonin Hypothesis.”

G Clarke et Al. “Minireview: gut microbiota: the neglected endocrine organ.” Molecular endrocrnlogy 28, no. 8 (2014):1221-1238. 

A.F. Athiyyah et al., “Lactobacillus Platarum IS-10506 Activates intestinal Stem Cells in a Rodent Model,” Beneficial  Microbes (May 4, 2018):1-6.

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Mind Body Medicine Sioux City

Using the Mind to Heal the Body

In guided imagery, you use your “mind’s eye” to picture the situation you are dealing with or the disease that is affecting you. Guided imagery connects the mind and the body by activating the parasympathetic response which results in relaxation. The body does not discern the difference between an image and reality and reacts with the same response of relaxation to imagery. In a state of total relaxation, the mind and body respond more to healing and growth.   Research has found that athletes that use imagery as part of a comphrensive program for healing after injury healed feaster Ievleva and Orlick (1999). 

Imagery involves using all of the senses to create an experience. There are two types of imagery: direct (when you choose a specific part in the body to heal), indirect (an image of something healing to promote a healing response in the body). 

Using imagery in the medical field has been studied in different areas. For example, cancer research on using imagery (psychoneuroimmunology) has found that patients report improvement in mood, decreased anxiety, decreased pain after surgery and improvement in quality of life (Baider et al., 2001; Burns, 2001; Donaldson, 2000). Patients with cancer are asked to visualize an army of soldiers (macrophages in the immune system) surrounding an enemy of invaders (cancer) and eventually subduing them. In other cases, patients were asked to visualize more abstract non tangible images, like certain colors, or flowing water as a source of healing going through the entire body.Dr Martin Rossman (Integrative Medicine) lists some areas where guided imagery can used for, including preparing for surgery, coping with chronic illness, managing pain and gear. 

Guided imagery can be done alone, listening to a recording or with an experienced guide. A guided imagery script usually include starting in a calm place, and has the listener imaging how s/he may approach a problem, or visualize the program change into something else. During this process, the person  becomes active in their own healing process, rather than being passive. 

Anyone can benefit from guided imagery, including adults and children. It may be harder at the beginning for adults to listen to a guided imagery as they tend to analyze the script. However, with continued practice, the benefits of guided imagery increase. Guided imagery is not meant to replace getting medical care or working with a healthcare professional, but is rather meant to enhance recovery and healing. People that have a history of trauma or psychosis should be cautious when using guided imagery and consult with a healthcare professional. 

Some resources that you may want to check out are:

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Mind Body Medicine Sioux City

The Polyvagal Theory: what happens in Vagus stays in Vagus

Have you ever found yourself at a social event, and felt uncertain about being there or in danger, but not really know why? You may look around and nobody else seems to be bothered at the event. 

You may not realize this but when you are walking around the world, your body is taking in many social cues about your environment. When you are interacting with others, your body is picking up facial expressions, tones of voice and bodily movements. All these cues continuously interact with your nervous system informing your body if the environment is a safe place where you can connect with others, or a dangerous place where you either have to run, fight or freeze. The interaction with the environment and the body’s way of relating to it is known as the Polyvagal Theory, a term coined by Dr Stephen Porges. The term that describes how our nervous system assesses whether people or places are safe, dangerous or life threatening is known as Neuroception

What is the Polyvagal Theory?

The Polyvagal Theory explains how our nervous system responds to stress or danger. It has a three part hierarchical system, all of which involve a cranial nerve called the Vagus Nerve. The Vagus nerve (Vagus- Latin for wandering) connects (or wanders) from the brain through all major systems in the body: the stomach and gut, heart, lungs, throat, and facial muscles! 

The three part hierarchical system means that only one part can work at any given times, while the other two parts take the back seat. 

  1. The ventral vagal system, also known as the safety system, green zone or social engagement system. When this system is engaged, the person feels safe, loved, is able to share feelings with others and be social while maintaining eye contact. The person is attuned to other people’s facial expressions and tone of voice. The person’s heart rate is regulated and is able to take in a full breath and breathe slowly. One is able to have a healthy blood pressure, good digestion, a healthy immune system and good sleep. The person is able to reach out to others and ask for help or support. 
  2. The activation system, also known as the sympathetic nervous system, yellow zone, fight or flight response. When this system is in charge, the person doesn’t feel at ease, doesn’t feel that others can be trusted, is constantly scanning the room for danger, is listening to sounds of danger instead of friendly voices. The person breath is shallow and the heart is racing. In such a state, the person may have elevated blood pressure, poor digestion, poor immune system and poor sleep. S/he may report more headache and back tension.  
  3. The dorsal vagal system, also known as immobilization, freeze system, or the red zone. When this system is engaged, as a last resort when the person was not able to fight or run away, the body shuts down or collapses. The heart rate slows down, the breathing slows down and becomes shallow so the point where the person may feel like fainting. The person may feel like they dissociate, report a foggy memory and no energy. The person may report weight gain, low blood pressure, stomach problems. Sometimes, when a person is in this state. s/he report feeling shame, or they feel trapped, or “too small to be seen or heard.” Quiet often, patients with post-traumatic stress disorder talk about how “they froze” when the trauma happened and feel shame, both of which can be explained by the third system kicking in as a response to danger. 

How Understanding Polyvagal Theory Can Help you Regulate Stress?

The more you understand which one of the three states you are in, the more you are able to engage yourself back into self regulation and retuning into the green state, the social engagement system. 

Here are a few things you can do to re-engage in the social system:

  1. Change your breathing, so that the exhalation is longer than the inhalation. This is often taught in yoga practices. Doing this reengages the ventral part of the vagus nerve, which in turn slows down the heart rate. 
  2. Seek environments that are soothing and where you feel safe, loved and connected.  For some people, it is walking in nature, for others, it is spending time with their pets or loved ones. 
  3. Listen to soothing music. 

For some people, seeking therapy also helps, especially when there have been traumatic events, where trying to engage the green state on one’s own has not been successful. 

Resources

Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience. https://www.frontiersin.org/articles/10.3389/fnhum.2018.00067

https://www.therapistuncensored.com/tu18-polyvagal-theory/.  Therapist Uncensored. 

The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. Stephen Porges, PhD. 

Attachment and Bonding: A New Synthesis. Stephen Porges, PhD.

Psychophysiology: Systems, Processes, and Applications. Stephen Porges, PhD.

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Mind Body Medicine Sioux City

Holiday Recipe

This article was originally written for and posted on Siouxland Magazine, where Dr Abu Ata is a regular contributor.

As you prepare your thanksgiving meal, consider adding the following ingredient, to enhance your mental health and help prevent mental illness, gratitude. Clinical trials show that gratitude can lower blood pressure, improve immune function, and promote happiness, acts of helpfulness and generosity. Beyond the physical benefits, people appreciate feeling thankful, seeing that they have been on the receiving end of kindness and generosity. 

Grateful people experience more positive emotions, such as joy, love, enthusiasm and optimism. They also have a better ability to be resilient, cope better with every day stress and recover quickly from physical illness. One of the ways to cultivate gratefulness that has been studied is gratitude journal keeping. Participants in this study were more likely to report having helped someone else or offered emotional support, sleep longer and spend more time exercising. 

Gratitude Interventions

“Counting Blessings”

Consider keeping a gratitude journal, and write daily about five benefits or gifts you have received in your life (also known as “counting blessings”). They could be simple every day pleasures, people in your life, moments in nature or gestures of kindness. As you are writing these things down, take a moment to cherish and savor these gifts. You may wish to do this in the morning when you wake up, or the last thing you do before going to sleep.

“Three Good Things”

Another variation on the above method involves writing three things that went well and identifying the causes of those good things. 

Mental Subtraction

This method involves imagining what life would be like if a positive event had not occurred. In one set of experiments, people who practiced that method reported improved mood (Koo Algoe, Wilson & Gilbert 2008). 

Gratitude Letters and Gratitude visits

Consider writing and delivering a letter of gratitude in person to someone who you had never properly thanked. (Seligman et al., 2005). 

Naikan Therapy

For some, having a structured method to cultivate gratitude is helpful.  Naikan therapy is an example of the structured self-reflection methods. Naikan is a Japanese word that means “looking inside” or “seeing oneself through the mind’s eye.” A Japanese Buddhist, Ishin Yoshimoto, developed this method in 1940s. 

Naikan therapy helps to shift one’s view from a limited one to a broader panoramic view. While one’s initial view is still there, after practicing the Naikan method, one is able to see much more that was previously hidden. The method provides a basis to reflect on relationships, events or specific periods of time.  The method involves three questions: 

  1. What have I received from ____?
  2. What have I given to___?
  3. What troubles difficulties have I caused ___?

Other ways of increasing gratitude include meditation, since meditation builds mindfulness, which in turn strength the quality and frequency of gratitude. Progressive muscle relaxation also helps increase a feeling of thankfulness and love. 

Living gratefully does not come naturally or easily; it takes discipline and practice, like any skill building. Gratitude must be purposefully cultivated. By writing every day, and setting aside a time for it, the ability to relish the small pleasures becomes second nature, a state of being. 

References:

Gratitude as a Psychotherapeutic Intervention. Yale Center. Robert A Emmons ad Robin Stern. 2013. 

The Science of Gratitude. Summer Allen, PhD. 2018

The To Do Institute. Naikan Therapy.