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How Does Stress Affect the Gut and Sleep?

We have all heard phrases like, "I have butterflies in my stomach" or "I just go with my gut" or "My stomach really does have a mind of it's own". From a sociological standpoint, we all instinctively know that there is a connection between the gut and the brain. The medical applications would be significant if this were true. But is it true? Can this link be scientifically validated?

Before we talk about the link between stress and the gut, let's talk a little about stress. Not all stress is bad. There is good stress called eustress which is essential to keep us motivated and have the physiological energy to wake up in the morning. Good stress provides a healthy challenge. Stress is damaging when the physical body cannot compensate, or when the mind percieves the situation as overwhelming.

For example, disrupted sleep is a stressor to the body and can change cortisol levels throughout the day contributing to symptoms of anxiety, fatigue and depressed mood. Research shows that 3 nights of disrupted sleep is enough to elevate cortisol at night which further perpetuates sleeplessness. Changes in cortisol levels can result in increased inflammation in the GI tract, increased cravings for sugar due to imbalances in insulin, and a slowed metabolism which may contribute to weight gain.

You may begin to see that this begs the "chicken or egg" question. I usually work with my patients to break these unhealthy cycles. The benefit of naturopathic medicine is that we work with each person's individual physiology. So rather than giving one pill that sedates you for sleep, but does not promote a restful and refreshed feeling in the morning, I use gentler and more specific therapies. Non invasive is sometimes misnomered as weaker, however, when used appropriately, they can have profound effects. For example melatonin is great for an inability to fall alseep, but it does not work for people who wake up multiple times during the night. There are some herbs that work much better for this other type of insomnia.

Stress and Increased Intestinal Permeability

So for those of you who are interested in the scientific link between stress and the gut, this is how it works:

  • Stress triggers the limbic system of the brain to release CRF and ACTH
  • CRF and ACTH travel to the adrenal glands where they stimulate release of cortisol and adrenaline
  • Cortisol and Adrenaline can activate immune cells that live in the gut wall to burst. These cells are called mast cells and release histamine when they burst.
  • Histamine stimulates the lymphocytes (immune cells) to start fighting, leading to an inflammatory response. The inflammed tissue in the gut is less intact and becomes more permeable, allowing particles that should stay in the gut, to leak out to the blood stream. When these foreign particles leak out to the blood stream, they further trigger more of an immune system reaction in the rest of the body.
  • This is how intestinal permeability can lead to auto-immune and allergic processes. This also explains how stress increases inflammation in the gut itself, leading to symptoms such as bloating, diarrhea, constipation, intestinal pain, mucous in the stools, etc. 

How to Help?

It is important to consider these principles when addressing intestinal health:

  • Remove (stressors, mibrobes, toxins and allergens)
  • Repair damaged intestinal mucosa
  • Restore healthy, beneficial bacteria that are essential to keeping the immune system balanced
  • Replace any necessary enzymes, HLC, or bile salts that may be deficient

Again being specific is important as studies show that certain probiotics in different dosages are more effective for certain conditions than others. I have patients who take the most common Accidophilus without much improvement, therefore it is helpful to seek professional help if your symptoms are not resolving. When used approprately, good quality nutritional supplements work well. My goal as a naturopathic doctor is to help promote your body to heal itself. Remember, our bodies are designed to be well. They have built in mechanisms to heal. It is when we suppress symptoms, emotions, or the body's cry for attention, that we push ourselves into more chronic sickness. When we address what is getting our attention, face it, love it, show it compassion and take steps to support healing, you'd be surprised at how resilient your body is.



To Eat or not to Eat...That is the Question

How does our attitude about food affect how successful we can be to achieve a healthy weight?

Angelina comes home from work at 8:30pm. Her team at work has successfully completed a month long project today and all she wants to do is to go home, have a couple glasses of wine, some comfort food and desert to reward herself. She is 5'6 165lbs. She used to be 130lbs when she was younger, but the weight has slowly crept up over the years. She has tried various weight loss programs and has been able to loose 20-25 lbs or so, but she seems to always gain it back. Why? What are some obstacles to her keeping the weight off? 

Growing up, Angelina's mom always rewarded her for good behavior with ice cream. Her mother would have lots of cheese and crackers if she was having a bad day to soothe herself. If she was having an especially bad day, she would say to her daughter, "Mommy's tummy looks so fat. I wish I looked like you. You make sure you don't eat too much so you stay pretty."

Many of my patients and friends believe that the less they eat, the less they weight. Calories in = Calories out. But that is not true. When you consume a food with less calories, for example a plain bagel, 70 calories (Panera Bread plain bagel 290 cal), compared to 2 eggs, 170 calories; it is natural to choose the bagel with 70 calories because it has the lowest calories. However the bagel is a carbohydrate, which means if you don't burn it, it gets converted by the liver into fat. The egg is protein and has much less of an effect on weight. Also, the bagel has almost no nutritional value, so when you consume it, your body is still asking you for more food, because it is nutrient deficient and you are more likely to crave more food after consuming the bagel. A study shows that people who consume zero calorie beverages are more likely to gain weight in 1 year than people who drink non-diet drinks. That is not to say that I am advocating for sugary non-diet drinks, but the zero calorie drinks may be worse because of the chemical effects the artificial sweeteners have on your brain, programing your brain to crave more food, because it is empty nutrition. Every type of food sends a different signal to your metabolism, so choose foods that are nutrient dense, and your brain will get the signal that you are satiated. This will help reduce cravings.

Another tendency I see is that people believe that the less they eat, the less they weigh. So especially with my busy patients, this is both convenient and works with their innocently misguided beliefs. Many people will have a coffee and skip breakfast, then have a light lunch at noon and not eat for 8 hours till they get back home from work. By that time they are starving, and will binge on foods for the rest of the evening. They often tend to eat more than they would have, if they had eaten nutrient dense meals and snacks during the day when the point of "hunger to no return arrives". Nutrient dense foods such as good quality proteins and healthy fats induce a chemical called somatostatin, that makes you full. Therefore, having these foods combined with fruits and vegies (which generally have zero effect on your weight), will help you feel full and reduce cravings. When you are overly hungry, your blood sugar drops very low which sends a message to your brain to eat the fastest thing that will elevate your blood sugar. That would be sugar and carbohydrates! But these foods will turn into fat if you don't burn them. So please eat breakfast and it is generally healthy to have some food every 3-4 hours.

Lastly with popular culture, we have often associated the word diet with beauty and restriction of food. This can have profound psychological effects on us when we view food this way. Hippocrates said, "let food be your medicine". So perhaps instead of thinking about restricting foods or calories; what if the paradigm was shifted to, "what foods can I choose to have more of, that nourish my body". And if you have more of nutrient dense foods, you probably would just naturally be more full and not want foods that do not support your body. I believe we all should live life, so do not feel bad if you ocassionally have deserts, or choose whatever you like when you eat out. Let's not punish ourselves with guilt that should not be. Rather let us be educated and make decisions that support our wellbeing. If you generally had 80-90% healthy foods, you would feel quite well. If you have 60% or more vegetables and fruit on your plate, you would also feel quite well. So to eat or not to eat, I'd say eat with gratitude.



How does dietary fat consumption affect the brain?

Did you know that the make up of your cell membrane depends on what you eat? In that sense, you are what you eat. The way your brain talks to your body is via cell-to-cell communication along nerves or neuronal tissue. If you eat a lot of trans fats such as those found in vegetable shortening, fried foods, and arachadonic acid found in red meat, these fats send an inflammatory signal to the nervous system.

Inflammation in the nervous system causes in increase in glutamate, which is an excitatory chemical in the brain. This can lead to symptoms of anxiety, hyperactivity, addictive tendencies and in-attention. Increase in inflammation and glutamate in the brain long term from chronic excessive brain firing causes neuron damage. This contributes to degenerative diseases like dementia, Alzheimer’s or Parkinson’s disease develop due to the oxidative damage this excessive inflammation produces. Also, consumption of inflammatory fats make cell membranes hard and rigid, blocking cell-to-cell communication.

If you eat lots of omega-3 fats found in fish, flax and walnuts your cell membranes are nice and malleable improving the structure and function of receptors on the cell. This allows for brain chemicals like serotonin, dopamine, and acetylcholine to communicate better with the cell helping positive mood, attention and memory. Another large component of cell membranes are phospholipids such as phosphatidyl choline and serine, which are found in high concentrations in the brain. They help balance stress hormone levels, decrease anxiety, improve memory, improve mood, and decrease aggression. Phospholipids can be found in lecithin, soy lecithin, egg yolks, sardines and nuts.  

Many studies show a correlation between depression and deficiency of omega-3 fatty acids. According to the journal of Nutrition and Healthy Aging, DHA, which is an omega-3 fatty acid is “one of the major building structures of membrane phospholipids of the brain and absolutely necessary for neuronal function”. The British Journal of Psychiatry, Did a study on prisoners. One group had their regular prison diet, and the other group was supplemented with Omega-3 fats. The prisoners who were given omega-3 fats had a 35% reduction in violent crime in prison. I’ve seen in my practice patients having great symptom improvement from depressive mood, anxiety and improvement in focus on a therapeutic dose of EPA and DHA.

Often times we think of supplements that are neurotransmitter specific first when seeing brain issues, but it is important to remember that basic nutritional sufficiency can make a very large difference in neurology. Be careful of low fat fad diets, as these diets often compromise brain function and lead to teenage learning problems and depression. Your brain needs fat to function, so eat the good fats.



How do you know the quality of your supplements?

The answer is sometimes an enigma. Two bottles may seem to have similar ingredients but one is clinically effective and the other not. For those that are not clinically effective, it can be a costly mistake.

My microbiology professor in medical school ran an experiment on probiotic supplements, culturing many different brands. Of the several brands she tested, unfortunately only three brands matched the advertized label. All the other probiotics did not meet label claims, for example, if the bottle claims 10 billion lactbaccilus accidophilus per servings, only about 4 billion were present indicating the product was not manufactured to be shelf stable. Even more shocking she found that some brands contained unwanted bacterial contaminants.

This is why I take the time to research supplements I use for my patients to ensure that they recieve the quality that they pay for and that they do not inadvertently get pesticides, heavy metals, PCBs, unwanted microbes in their products. I may not be able to tell if a certain product found on the internet is of good quality, because it is not possible to put hours of research to investigate the quality control protocols of the many companies that are out there.  I am however careful to choose products in my practice i can be confident that are of the highest quality.

When you purchase supplements, ensure that they are GMP (Good Manufacturing Practice) certified. For example, Metagenics, a company I use in my practice is certified by three third party GMP organizations, one of which is an Australian agency, TGA (Therapeutic Goods Administration) who's standards are 10 times  stricter than the FDA in the United States. Metagenics is the only company to achieve GMP certification from 3 leading external quality control agencies. That is not to say that there are not many other wonderful companies who manufacture products that are effacacious, environmentally friendly, and pure.

The shocking video below shows how supplements can be manufactured in people's home kitchen, and illustrates that nutritional supplements vary in quality. It is important to do your research or consult a health professional who is knowledgeable in this field. However, this article is not intended to create paranoia about supplements but to empower you to choose sources that are manufactured properly, meet label claims, and give you what you pay for. The graph (right) shows how safe nutritional supplements are compared to medications even if some were not manufactured in "Cadillac" quality facilities. In 2008, the US had 48,700% more AERs (Adverse Event Reports) for prescription drugs compared to supplements. According to the FDA, an AER is anything from a concern that a supplement isn’t working, to a serious illness that follows the consumption of said supplement. In conclusion, using a natural product is still more safe, produces less side effects, and is less invasive than prescription drugs.


Keeping Your Immune System Strong

1. Hot and Cool Showers: You have heard the old wives tale about catching a cold when you get chilled. Even though western medicine says that it is a myth, it may have some truth to it. While you do not necesarrily "get" a virus from the cold, energy may be diverted away from your immune system when you are chilled in efforts of keeping your body temperature stable.

Hot and Cool showers are different because you are exposing yourself to about two rounds of 15-30 seconds of cool water when your body is already warm from the hot shower. That burst of cold actually trains and stimulates your vascular system to constrict faster in response to cold, thus better preserving the heat in your body. You may notice that after taking hot and cool showers for a while that you feel warmer and retain heat better in the cold months. Also brief cold water exposure increases your white blood cells, interleukin-4 and gamma interferon which help fight viruses.

2. Laugh: Laughing and enjoying company can raise endorphin levels (happy hormones), which have a possitive effect on decreasing your stress hormones such as cortisol, and balance your immune system. If your family is stressing you out, try cracking some jokes. You may find that even if you force yourself to laugh, pretty soon, you truly feel happier.

A field of medicine called psychoneuroimmunology studies the relationship of your mood with your nervous sytem and immune system. A research article titled, Sociability and Suceptibility to the common cold showed that people who were more sociable had a lower probability of developing the common cold. Sociability in this study was associated with extraversion, agreeableness and positive relationship style.

3. Vitamin C: When it comes to the immune system, we always think about Vitamin C. Yes, taking 1000-3000mg of vitamin C with bioflavonoids daily during the winter months is a great way to give your immune system a boost. I find that if you feel run down, immediately taking 500-1000mg of vitamin C every hour can in some cases prevent you from geting sick. If your stools get loose, decrease your dosage of vitamin C, but many people can easily tolerate 10,000mg of vitamin C a day.

It is important to recognize the beginning signs of fighting an infection and learn be in tune with your body. Once you come down with a cold, you will still have to go through it, so it is easier to prevent one. Sometimes people will only feel more tired as a sign that they are fighting a virus, and will have no cold symtpoms. Other symptoms that you are possibly fighting a virus may be back pain, headache, feeling more moody, sneezing, or a light tickle in the throat. If you can learn to feel and quickly take action when you have a virus coming on, you've now learned a new tool to increase your chances of eleminating the bug before you even get sick.

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