Author: Eva Flo

Picture this!.. You are in front of your computer screen and you see that something sad and stressful has happened somewhere in the world and you, in turn, feel sad and stressed… Immediately afterwards, you see a picture of a character eating an ice cream and suddenly you get a pleasant feeling that brings you relief from your stress. What happened here? Why do certain foods produce a cascade of pleasant emotions in us? Behind this, there is something emotional and mental going on, something that goes beyond the functional and that helps us explain the relationship between the intestinal microbiota and the brain.

The gut-brain axis is an increasingly studied system that explains why your mood can be affected by what you eat or drink. When the digestive and nervous systems work in harmony they can provoke positive mental and physical reactions. We now know that the health of the gut microbiota can influence reduced stress, improved cognitive function, greater emotional balance and better sleep. In the past, scientists considered the brain to be the most important organ when it comes to mental health. However, more and more evidence is beginning to reveal the importance of gut health. It is estimated that 90% of all mental health problems have a connection to what happens in our intestines.

WHY IS THE INTESTINE CONSIDERED THE SECOND BRAIN?

The gut-brain axis is a communication link between the gut and the brain. It includes four main pathways that allow the brain and digestive system to send and receive signals to each other. These are the connection routes:

• Neuroendocrine pathway – This pathway is the communication between the hypothalamus and the gastrointestinal tract. The hypothalamus, the part of the brain responsible for emotions and motivation, receives cognitive and behavioural signals that affect hormones and gut symptoms.
• Autonomic nervous system – This pathway transmits signals from the brain to the organs of the digestive system that control digestion and is responsible for processes related to digestion, such as the production of digestive enzymes and the speed of the digestive process.
• Immune response – This pathway determines how the body reacts to specific foods, bacteria, or viruses within the digestive system and how the body communicates those reactions to the brain. It is responsible for maintaining the balance between the immune system and the rest of the body since an imbalance (intestinal dysbiosis) can cause digestive problems.
• Enteric nervous system – Lastly, the enteric nervous system connects the neurons of the gastrointestinal tract to the brain and is responsible for the digestion of food, absorption, and secretion of digestive juices into the gastrointestinal tract.

WHICH ILLNESSES SHOW A GUT-BRAIN CONNECTION?

Depression and anxiety are possibly two of the most common mental health problems associated with an altered gut-brain axis. Studies have found that an unbalanced gut microbiota can affect the hippocampus – responsible for regulating mood – resulting in increased anxiety and depression.

As Professor Ted Dinan and his colleagues from University College Cork (Ireland) explain in the latest issue of the journal Neurogastroenterology & Motility, several recent studies show that in animal models, depression and anxiety are related to an alteration in the composition of the intestinal microbiota.

Understanding the relationship between emotions and the microbiota could lead to the development of “new treatments for a wide variety of pathologies including obesity, mood disorders and gastrointestinal ailments”, concludes Professor Dinan.

Research by gastroenterologist Premysl Bercik, from McMaster University (Canada), also supports these ideas. In experiments with mice, Bercik verified that, after modifying the composition of the microbiota of specimens that had a passive behaviour pattern, they changed their “personality” (exploratory behaviour), became more exploratory and tended to seek novelty and risk. Blues Bacteria or How the Microbiota Can Affect Mood – Gut Microbiota for Health

In 2019, a macro study was published with more than a thousand patients in which the composition of the intestinal microbiota is correlated with quality of life and depression. The researchers found that the butyrate-producing bacteria Faecalibacterium and Coprococcus were consistently associated with indicators of good quality of life. On the other hand, Dialister and Coprococcus bacteria were decreased in people with depression. (Valles-Colomer, et. al, 2019) In a second study parallel to the previous one, the intestinal microbiota and its relationship with depressive symptoms were characterized in six ethnic groups (Dutch, South Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan) from the same urban area (the city of Amsterdam). , in a total of 3,021 people. The results confirmed those obtained in the previous work, and showed that the intestinal microbiota linked to depressive symptoms was independent of ethnic group.

In 2019, a macro study was published with more than a thousand patients in which the composition of the intestinal microbiota is correlated with quality of life and depression. The researchers found that the butyrate-producing bacteria Faecalibacterium and Coprococcus were consistently associated with indicators of good quality of life. On the other hand, Dialister and Coprococcus bacteria were decreased in people with depression. (Valles-Colomer, et. al, 2019) In a second study parallel to the previous one, the intestinal microbiota and its relationship with depressive symptoms were characterized in six ethnic groups (Dutch, South Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan) from the same urban area (the city of Amsterdam), in a total of 3,021 people. The results confirmed those obtained in the previous work and showed that the intestinal microbiota linked to depressive symptoms was independent of ethnic group.

HOW TO IMPROVE BRAIN AND GUT COMMUNICATION

The importance of treating disorders of the gut-brain axis is increasing in light of recent research: with gut health linked to mental health, it is increasingly crucial to understand and treat problems related to the gut-brain axis.

GABA, SEROTONIN AND OTHER NEUROTRANSMITTERS

Gamma-aminobutyric acid (GABA) is a very common amino acid in brain neurons. It is believed to calm neurons and protect our brain against stimulus overload, which is why it has been linked to reducing stress and improving sleep.

Research has revealed the role that the microbiota plays in GABA production. The prestigious journal Nature reported that the production of GABA by bacteria reduces pain by acting on sensory neurons in the stomach. Another article, published in the same journal, revealed a link between depression and the relative abundance of bacteria that synthesize and degrade this neurotransmitter.

CHANGE! PREBIOTICS AND OTHER TIPS

• Prebiotics: Prebiotics are a type of fibre that stimulates the growth of healthy bacteria. Among the foods rich in prebiotics are artichokes, bananas, mushrooms such as Lion’s mane (its standardized organic extract contains GABA), Shiitake or Pleurotus, asparagus, oats and apples.
• Varied foods: This can lead to a diverse microbiome, which is an indicator of good gut health. In particular, legumes, beans and fruit contain a lot of fibre and can support the growth of healthy bifidobacteria.
• Worst: Red Meat: Red meat can trigger the growth of gut bacteria that lead to clogged arteries. Stick to lean protein sources such as fish or plant protein like beans and tofu. If you can’t give up beef, pork, and lamb completely, choose leaner cuts with names that include round, loin, or sirloin.
• Fried Foods: Fried foods are already on the not-good-for-you list. It hasn’t been proven in humans yet, but studies on rats show that heated oil, which soaks into fried foods, can damage healthy gut bacteria.
• Foods With Antibiotics: Antibiotics can’t tell the difference between “good” and “bad” bacteria, so they kill them all. Often, farmers treat animals with antibiotics to keep them from getting infections. If you eat these animal products, you can kill the healthy bacteria in your gut. And because some bacteria become antibiotic resistant over time, meaning the drugs no longer affect it, you might end up with a hard-to-kill superbug.
• Alcohol: Alcohol, especially if you’re a heavy drinker, can disrupt the balance of bacteria in your gut and help bad bacteria grow. Moderation is key.
• Caffeine: Coffee, soda, and even too much chocolate can up the caffeine in your body, which ramps up your intestines. This excitement in your digestive system often causes diarrhoea.
• Fermented foods: Fermented foods like yoghurt, sauerkraut, and kefir contain healthy bacteria, primarily lactobacilli, and can reduce the number of disease-causing species in the gut.

• Whole Grains: our body can’t break down fibre on its own. When it gets to your large intestine, gut bacteria get to work fermenting it. This creates acids that feed cells in your intestines while helping to protect your gut from harmful bacteria.
• Polyphenols: These compounds in foods protect your cells from damage while fighting inflammation and infection. Colourful foods are rich in polyphenols, as are tea, coffee, and red wine. Polyphenols in green tea may help fight “bad” bacteria like E. coli and calm symptoms of inflammatory bowel disease (IBD) and peptic ulcers. Polyphenols can also promote the growth of good gut bacteria.
• Limit your exposure to stress: Uncontrolled stress can damage the gut-brain axis, as it can cause damage to both the neurons in the gut and the hippocampus of the brain.
• Releases the happiness hormone: Regular exercise promotes the release of endorphins, which can help improve mood and reduce stress levels, as well as increase the amount of beneficial bacteria in the gut.
• A good rest: Poor sleep can have a detrimental effect on mental health and damage the gut-brain axis.
• Avoid artificial sweeteners: Some tests have shown that artificial sweeteners such as aspartame increase blood sugar by stimulating the growth of unhealthy bacteria such as Enterobacteriaceae in the gut microbiome.

REFERENCES

https://regenerahealth.com/

Melancholic microbes: a link between gut microbiota and depression? – PubMed (nih.gov)

Gut bacteria linked to behavior: That anxiety may be in your gut, not in your head | ScienceDaily

The neuroactive potential of the human gut microbiota in quality of life and depression | Nature Microbiology

The gut microbiota and depressive symptoms across ethnic groups | Nature Communications

http://download.journals.elsevierhealth.com/pdfs/journals/0016-5085/PIIS0016508511602308.pdf

https://www.nature.com/articles/s41564-018-0337-x

Pictures of the Best and Worst Foods for Gut Health (webmd.com)

Tea Compounds and the Gut Microbiome: Findings from Trials and Mechanistic Studies – PMC (nih.gov)

“The curious paradox is that when I accept myself just as I am, then I can change” (1995). “Taking a stance of non-judgmental awareness and actively embracing the experience of thoughts, feelings, and bodily sensations as they occur” (Hayes et al., 2004) 

What is acceptance?

Acceptance is a self-regulation strategy that involves an open and welcoming attitude toward one’s own emotions, thoughts, or external events. 

Why is acceptance important?

It is important for our mental health because it can help us cope with difficult situations and emotions without resisting or denying them. Acceptance can also facilitate healing and recovery from various psychological problems, such as stress, pain, anxiety, depression, and addiction. Additionally, it is important nowadays because it can help us cope with the uncertainty and challenges of life. 

Acceptance means consenting to the reality of a situation or a person’s choice without trying to change it. It can help us move from feeling any emotion to actually being that emotion, as we stop resisting and start embracing what is. Moreover, acceptance can foster our personal growth and development by helping us learn from our experiences and find the lessons in them. Acceptance can also enhance our relationships with others by respecting their choices and opinions without judgment

What can I gain when I accept myself?

• Being able to see yourself fairly accurately and recognize what you are and aren’t good at
• Embracing all the parts of yourself—even the negative ones—and being happy with who you are
• Accepting your values, preferences, resources, feelings, intuitions, and actions—both past and present
• Recognizing your strengths and accomplishments without being overly vain about them
• Learning to acknowledge your weaknesses and faults without beating yourself up over them or engaging in overly excessive negative self-talk
• Having a positive attitude toward yourself and holding yourself in high regard, without the need for others’ approval
• Seeing yourself as a whole human being, rather than defining yourself by any one characteristic, incident, ability, or weakness
• Being able to love and respect yourself

ACCEPT vs AGREE

Acceptance and agreeing are two different concepts that are often confused. Acceptance means consenting to the reality of a situation or a person’s choice without trying to change it. 

Agreeing means having the same opinion or granting consent to something or someone. You can accept something without agreeing with it, and you can agree with something without accepting it. For example, you can accept that your friend has a different political view than you, but you don’t have to agree with it. Or you can agree that your colleague did a good job on a project, but you don’t have to accept that he deserves more credit than you.

Psychological acceptance is a term that refers to the process of not simply noticing but also embracing one’s experience without judgment or defense. It is different from accepting the status quo of one’s life situation, which may imply passivity or resignation. Psychological acceptance means taking a stance of non-judgmental awareness and actively embracing the experience of thoughts, feelings, and bodily sensations as they occur. Psychological acceptance is important for our well-being because it can help us cope with difficult emotions and situations without resisting or avoiding them, which can cause more psychological harm. 

How can I practice acceptance in life?

There are many ways to practice acceptance in life, but here are some common steps that can help you cultivate this skill:

• Notice your resistance. Pay attention to how you react when you face a difficult situation or emotion. Do you try to avoid it, deny it, or distract yourself from it? Resistance can be a sign that you are not accepting what is happening.
• Question your patterns. Ask yourself why you are resisting your experience. What are you afraid of? What are you trying to protect yourself from? What beliefs or expectations are you holding on to that are causing you pain?
• Be mindful. Mindfulness is the practice of being present and aware of your thoughts, feelings, and sensations without judging them. Mindfulness can help you observe your experience with curiosity and openness, rather than resistance and criticism.
• Consider your inner child. Sometimes, we resist our experience because we feel ashamed, unworthy, or unlovable. These feelings may stem from childhood wounds that have not been healed. Imagine how you would treat a child who is going through what you are going through. Would you be harsh and critical, or kind and compassionate? Try to treat yourself the way you would treat a child who needs your love and support.
• Embrace your uniqueness. Acceptance also means appreciating yourself for who you are, with all your strengths and weaknesses. Instead of comparing yourself to others or trying to fit in, celebrate what makes you different and valuable. Recognize your achievements and talents, as well as your areas of growth and improvement.

• Forgive yourself: If you’ve made a mistake, acknowledge it and learn from it, but don’t berate yourself for it repeatedly. Learn to forgive yourself for your mistakes.
• Avoid self-blame: Recognize that you are not the cause of all the negative situations you encounter. Try to be objective and evaluate other factors that may have played a role in the circumstances.
• Don’t compare yourself to others: Try to be a better version of your previous self, instead of making comparisons to others.

• Focus on positivity: Make an effort to see the silver lining in every situation. Rather than focusing on what you did wrong, try to identify at least one thing you did right. If you have a negative thought about yourself, reframe it and replace it with a positive one instead.

• Keep a journal: Maintain a journal where you note down your strengths and accomplishments, as well as your weaknesses and disappointments. If you are having difficulty accepting something, it can be helpful to note down your thoughts about the situation and what you could have done differently. This can help you implement changes in the future and act more in accordance with your values.
• Try loving-kindness meditation: Loving-kindness meditation is a form of meditation that can help you build positivity, compassion, and equanimity. It involves thinking positive thoughts for yourself, appreciating yourself just the way you are, and saying affirmations out loud. 
• Seek help: It may be helpful to see a mental health professional, if you feel that a lack of self-acceptance is disturbing your peace of mind, causing you to experience symptoms of anxiety or depression, interfering with your ability to eat or sleep, affecting your work, or harming your relationships.

References

Dimeff, L., & Linehan, M. M. (2001). Dialectical behavior therapy in a nutshell. The California Psychologist, 34(3), 10-13.

Hanson, R; 2009; Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom; New Harbinger Publications; Oakland, CA.

Hayes, S. C., Strosahl, K. D., Bunting, K., Twohig, M., & Wilson, K. G. (2004). What is acceptance and commitment therapy?. In A practical guide to acceptance and commitment therapy (pp. 3-29). Springer, Boston, MA.

Kabat-Zinn, J; 2005; Coming to Our Senses: Healing Ourselves and the World Through Mindfulness; Hyperion Publishers, New York, N.Y.

Rogers, C. R. (1995). On Becoming a Person: A Therapist’s View of Psychotherapy. Houghton Mifflin Harcourt.

Williams, M; Teasdale, J; Segal, Z; Kabat-Zinn, J; 2007; The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness; The Guilford Press; New York, NY.

Often, when we think of mental illness, we visualize the individual’s suffering, however, when the individual is supported by family, the family becomes an unconscious and invisible sufferer. Yet, family members are considered the support team; their suffering and stress are rarely recognised. These tired mothers and fathers, daughters and sons, husbands and wives deserve attention as well. If we review the impact worldwide, in countries like India for instance, family is the key resource in the care of patients with mental illness due to their traditions and population volume. What is more, in Chinese society, Pearson and Lam, 2002 observed that “in countries with low-income levels and numerous existential stressors, changes in family structure may make the caregiving burden even more onerous”. (Avasthi, A., 2010)

Equally, when we focus on mental health symptoms in regards to family impact, it can weave a web of doubt, confusion and chaos. Unwittingly, the person with mental illness can dominate the entire family through control and fear or helplessness and incapacity. Like a bully, mental illness bosses the primary sufferer as well as their loved ones. Instability, separation, divorce and abandonment are frequent family outcomes of mental illness.

FACTORS IMPACTING FAMILY

The five factors that bind families to the despair of their loved one’s illness are stress, trauma, grieving, loss and exhaustion.

Stress is at the foundation of the family experience of mental illness. There is constant tension, dread and worry because the illness can strike anytime. It’s common for family members “to walk on eggshells”.

Another form of trauma is “witness trauma“, where the family watches helplessly as loved ones are tortured by their symptoms. This type of family atmosphere can often induce the development of traumatic symptoms like invasive thoughts, distancing and physical disorders. The result can be traumatic stress or posttraumatic stress disorder. Much of the family’s despair results from trying to manage and control what it cannot. Knowing when to intervene is one of the most difficult lessons a family must learn.

Grief occurs from this steady diet of loss. Family members can go through protracted grieving, which often goes undiagnosed or untreated. Grieving centres around what life will not be.

Loss lies in the very nature of family life. Family members report losses in their personal, social, spiritual and economic lives. They suffer losses in privacy, freedom, security and even dignity.

Exhaustion is the natural result of living in such an atmosphere. The family becomes an endless emotional and monetary resource, and must frequently monitor the concerns, issues and problems of the ill loved one.

Other symptoms can be worry, preoccupation, anxiety and depression and can leave the family drained emotionally, physically, spiritually, and economically. The family members can develop symptoms including denial, minimization, enabling, high tolerance for inappropriate behaviour, confusion and doubt, guilt and depression, and other physical and emotional problems.

What can families do?

In response to pain, the family can learn to develop a disciplined approach to dealing with their situation.

First, they can transform the way they think and feel and move from denial to awareness. When the reality of the illness is confronted and accepted, healing begins.

The second transition is a shift in focus from the mentally ill person to attending to self. This shift requires the establishment of healthy boundaries.

The third transition is moving from isolation to support. Facing the problems of living with mental illness is too difficult to do alone. Family members need to work within a framework of love. This makes it easier to relate to the illness with distance and perspective.

The fourth change is family members learning to respond to the person instead of the illness itself.

The fifth and final shift toward healing occurs when members find personal meaning in their situation. This elevates the personal, private and limited stories of the family to a much larger and more heroic level. This shift doesn’t change what happened or even take the hurt away, it just makes people feel less alone and more empowered. It creates choices and new possibilities. Staff, H. (2021, December 22)

PUBLIC SERVICE SUPPORT

Early therapeutic interventions, including family interventions, should focus on expanding training to patients and key relatives about wellness recovery, skills training, and task sharing of household and self-care chores.

Access to better treatment for patients is very important. This includes medications, psychosocial interventions and rehabilitation services. Caregivers need to be supported through active programs of support and guidance rather than being left in the lurch.

More attention needs to be given to the mental health and well-being of family caregivers by developing a locally applicable theory of rehabilitation, testing interventions in each country or region according to tradition and seeing if they can be applied. (Avasthi, A., 2010)

REFERENCES

Avasthi A. Preserve and strengthen family to promote mental health. Indian J Psychiatry. 2010 Apr;52(2):113-26. doi: 10.4103/0019-5545.64582. PMID: 20838498; PMCID: PMC2927880.

Pearson V, Lam PC. Family Interventions in Mental Illness: International Perspectives. In: Lefley HP, Johnson DL, editors. On their own: caregivers in Guangzhou, China. Westport, CT: Praeger; 2002. pp. 171–83.

Staff, H. (2021). The Effect of Mental Illness on the Family Relationship, HealthyPlace.

From childhood, we’re often told to adapt ourselves to make others feel comfortable. For instance, in schools with dress codes, we are told what we should wear or within our personal lives with family, we are told we are being rude if we do not display certain social behaviours (“I don’t care if you don’t want to hug your uncle, it’s rude not to!”). The pressure to conform is always there.

Unfortunatelly, we are taught that in order to not offend or hurt others, we need to put the feelings of others ahead of our own needs. This can lead to us being unaware of what our own boundaries are in our adulthood. If we look at the word “boundary” itself in the Cambridge English dictionary, it is defined as “a real or imagined line that marks the edge or limit of something, the limit of a subject or principle, the limit of what someone considers to be acceptable behaviour.”

So what are personal boundaries?

Personal boundaries can be understood as the lines we create for ourselves in terms of our level of comfort around others. In other words, it is what we feel is right for ourselves and its violation can lead to discomfort. (Welsch, von Castell and Hecht, 2019)

Boundaries can be also:

• Physical (related to hugging others or our physical space),
• Verbal (how others talk to us),
• Emotional (our emotional well-being),
• Sexual (protecting our needs and safety sexually),
• Material (our personal belongings),
• Related to time (use and misuse of our time),
• Environmental (home, work, family, friends)
• Social media related (related to healthy and respectful communication).

Personal boundaries don’t have to be expressed for them to exist. However, they are more likely to be violated if we don’t communicate them. As social psychology researcher Brene Brown says, “clear is kind, unclear is unkind.” Once you know your boundaries, you can communicate them. 

Do we need to communicate Boundaries?

Although it isn’t always easy and not everyone may agree or understand them, when we don’t communicate our boundaries they are more likely not to be followed. It can be challenging to set boundaries, but once we do it, we can feel comfortable knowing our needs have been communicated. And, if someone chooses to violate our boundaries after that, we would be within our rights to create further distance between ourselves and that person or choose to stop contact with that person.

Why is setting healthy boundaries important?

Not everyone has the same boundaries. Most people aren’t able to guess what another person’s boundaries are. People who may have lower emotional intelligence (EQ) can gain an understanding when personal boundaries are clearly communicated to them. Additionally, it helps to communicate our needs for a healthy interaction with someone else. One way to practice long-lasting self-care is to set healthy boundaries with the people in our lives. Boundaries are dynamic, ever evolving and will change with us as we grow, meet new people and become aware of what we need for our mental or physical health.

How do we set healthy boundaries?

Define your limits (what your needs are, what supports and detracts from your well-being)
Openly communicate your boundaries to people in your life
Remind people if needed (sticking to your boundaries and needs)
Don’t be afraid to say “no” to things that don’t serve you
Take time for yourself

References

Welsch R, von Castell C, Hecht H. The anisotropy of personal space. PLoS One. 2019 Jun 4;14(6):e0217587. doi: 10.1371/journal.pone.0217587. PMID: 31163063; PMCID: PMC6548369.
Faitakis, M., 2021 https://www.thesmujournal.ca/editor/the-importance-of-setting-boundaries