By Karla Cloete
Edited by Tasmiyah Randeree, Kemiso Wessie & Randy Tsubane
Anxiety, depression and stress. Our minds and bodies are closely intertwined, as are our mental health and our gut. We spoke to two young dieticians about the new research emerging from this area.
Trigger warning: Eating disorders
Disclaimer: The following information is not intended for diagnosis or treatment. This article is meant to educate on both health and nutrition. Always seek out the advice and guidance of certified medical professionals.
“Meanwhile I was thinking that if half the cells inside of you are not you, doesn't that challenge the whole notion of me as a singular pronoun, let alone as the author of my fate?”
This is what Aza Holmes, the protagonist of John Green’s Turtles All the Way Down, considers while cheerily informing us that we are only 50% human. The other half is purely microbial, a large chunk of which resides in our digestive tract. For a nihilistic teenager, she’s not far off on how these microorganisms can shape our well-being:
If you’ve ever had a stomach ache before a presentation or had butterflies on a first date, you know that the brain and emotions can have an impact on your digestive system, but we don’t always consider the reverse to also be true.
A 2017 trial of adults with major depression found that a Mediterranean diet combined with various forms of therapy resulted in full remission from depression in 32% of participants as opposed to the 8% only receiving clinical help. We’re only just learning how closely our minds and microbes are linked.
According to Harvard Health, the brain and the gastrointestinal (GI) system are very closely interlinked. Issues in the stomach and intestines can cause anxiety, depression, or stress and vice versa.
The gut microbiome is, essentially, its own ecosystem filled with a vibrant and diverse community of bacteria, viruses and fungi that need to be protected and maintained. The more vibrant your inner ecosystem is, the better your overall health. These inhabitants are made up of the good, the bad, and the microscopic ugly. A careful balance and overall diversity need to be maintained for there to be more beneficial bacteria in order to maintain good health.
Disruptions to the microbial balance could lead to diseases in both our bodies, as well as our brains. The latest neuropsychology includes preliminary investigations into the link between the microbiome and mental health disorders such as bipolar disorder and schizophrenia. Studies have shown that by corralling the bacterial population in our GI (gastrointestinal tract), we can reduce many of the symptoms associated with psychological disorders- and of course improve overall mental health. It affects us so much that some scientists call it our “second brain”.
Reversely it’s also been found that psychological interventions can be more effective for people with digestive problems than solely using medical treatment.
To EmpowHER sat down with two registered dieticians to discuss these findings. Jessica Nathan (23) and Sabeeha Abdullah (24) run their practice Go Grow Glow, in Cape Town. While at Stellenbosch University and during their community service year, they worked hard and realized that they shared a similar vision for their future practice, and complemented each other well.
They both agree that people generally misunderstand what dieticians do. People mistakenly believe that they only create diets and help facilitate weight loss. Most don’t realize that they can also work with ICU patients, people with feeding tubes, in foodservice and in research.
Mental health makes up an important component of a dietician's overall assessment as it influences their eating behaviour, their food choices, and a diet to comply as well as to stick to their individual plan.
Abdullah has personally experienced how much a diet helped her own mental health struggles. She developed anxiety during her second year of university and had to be hospitalised for multiple anxiety attacks.
With support from loved ones, professionals and a healthy diet, she was able to improve her anxiety and complete her studies. She now runs a successful practice.
Her own interest in women’s health stems from her experience with stage 4 endometriosis. After having surgery and being diagnosed, she began using diet and lifestyle as powerful tools to manage her symptoms, balance her hormones and heal her gut.
But which comes first: the mental health challenges or issues in the gut.
It becomes a chicken-and-egg conundrum. Abdullah says it's hard to know:
This connection goes both ways: A troubled intestine can send signals to the brain, just as a troubled brain can send signals to the gut. Therefore, a person's stomach or intestinal distress can be the cause or the product of anxiety, stress, or depression. That's because the brain and the gastrointestinal system are intimately connected.
Our mental state, such as daily stress and anxiety, can inhibit the gut’s function. In reverse, our gut produces 95% of the happy hormone serotonin and the ever-changing levels of gut bacteria can influence our emotional regulation and moods.
According to Abdullah, the following are potential indicators of an unhealthy gut:
Moodiness, anxiety and depression.
Sleep disturbances such as insomnia, poor sleep or chronic fatigue due to the gut not producing enough serotonin (a mood and sleep hormone).
Skin conditions such as eczema.
Food intolerances. This is caused by difficulty in digesting certain foods that result in bloating, gas, diarrhoea, abdominal pain, and nausea.
If you think that’s too much power for an invisible microcosmos in your belly to have over you, it gets more abnormal. Some of the critters in our microbiome can even communicate directly with our brain by emitting neurotransmitters! Certain studies in mice have even suggested that the bacteria in our gut can affect our ability to function socially.
The gut obviously has a perplexing role in our mental health. As if mental health struggles aren’t complicated enough on their own, it can be even harder when they revolve around food.
Nathan grew up with an unhealthy relationship with food. In high school, this turned into an eating disorder. Her eating was highly restrictive and repetitive.
She became obsessed with food, compulsively reading about diets and health, trying to create healthier recipes, and calculating the nutritional differences over and over again. She was depressed and malnourished. Her skin looked purple and she was rapidly losing hair.
She saw first-hand how a change in diet and relationship with food could improve her mental well-being.
Ultimately, Nathan came across a television program about a dietician who specializes in helping those who suffer from eating disorders. This helped reshape the relationship patients had with food and with their own bodies; that is when she knew this is what she wanted to do with her life.
Nathan and Abdullah now work every day to educate people on their bodies as well as on their eating habits so that they can live healthier, and work on maintaining a balanced life.
If you’re concerned about your gut health, there are simple things you can focus on to better your biome. Gut health and microbial order can be improved through a healthy well-balanced diet rich in:
Probiotics: These fermented foods contain living bacteria that are very good for you. Think stinky foods like sauerkraut, cottage cheese, kimchi, kefir or just plain yogurt.
Probiotic supplements have been found to help alleviate some of the symptoms pertaining to anxiety, depression and OCD (Obsessive Compulsive Disorder) when used as advised by medical and mental health professionals.
Prebiotics: These do not contain helpful micro-critters, but promote a healthy GI tract because they contain indigestible fibers for the probiotic bacteria to feed on. (Gross, but important to think about.) This includes garlic, legumes, oats, cabbage and onions.
Keeping your body and brain health is complicated and often quite overwhelming, however, you don’t have to do it alone. Simple changes go a long way and there are a number of professionals who aid you in developing a holistic approach to both.
In the words of Green’s Aza Holmes: “What I love about science is that as you learn, you don't really get answers. You just get better questions.”
Let’s just start by asking better questions.
Recommended further reading:
Harvard health blogs under 5 minutes:
Ted Talks under 15 minutes:
More about Sabeeha Abdullah and Jessica Nathan:
Jessica grew up in Durban and Johannesburg. She studied dietetics at Stellenbosch University and she specializes in eating disorders as well as diseases of lifestyle. Jessica loves playing the piano, hiking and baking.
Sabeeha grew up in Mpumalanga, but moved to Dubai at age 9 where she continued her education. She also completed her degree at Stellenbosch University. Sabeeha specializes in women’s health (specifically conditions such as endometriosis and PCOS - Polycystic Ovary Syndrome) and in gut health. She loves to travel, enjoys being outdoors and adores horse-riding.
Their overall practice also works with anything ranging from diabetes, cholesterol problems, nutritional support for fertility to weight loss and hormonal imbalances. They are both registered with the Health Professions Council South Africa (HPCSA) and the Association of Dietetics South Africa (ADSA).
You can get in contact with them on their website or through their social media:
Article Sources:
Karla Cloete is a 22-year-old student from Gauteng, currently doing her honours in Creative Writing at North-West University. She did both her undergraduate and honours degree in psychology.
She is an avid reader and plant collector. She is also passionate about mental health, women’s rights, and working with young people and children. Karla dabbles in art and loves participating in debate in her free time. She also has a background in theatre and acting. Her ultimate goal is to become a psychologist and to work in children’s literature.
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