You Are What You Eat?

Written by Dr. Rupali Chadha

Editor’s Note: New research reveals even tighter bonds between gut health and overall health - body AND mind.

Ever heard the expression, you are what you eat? More and more we are finding that what we consume affects our brains, not just our bodies. Many physicians have started educating their patients on the dangers of the Standard American Diet (SAD) and heavily processed foods. In this endless merry-go-round of what is considered healthy, fat has been demonized and lately carbs and sugar. But is the picture much more complex? Could it be that it’s not completely what we eat, but what the billions of bacteria in our gut “let” us eat?

Gut microbiomes have become a hot topic lately. From actual scientific research to health adjacent businesses marketing probiotics, from everything to anxiety to erectile dysfunction. But the actual science is exciting and something to explore in healing our brains!

For a long time many of us psychiatric physicians have seen a mind- brain-gut connection. When we get excited or nervous we have “butterflies in our stomach.” Many gag when disgusted or have a bathroom run when anxious. The most common side effects when starting SSRIs (Selective Serotonin Reuptake Inhibitors, a class of antidepressants) are gastrointestinal (nausea, vomiting, diarrhea). It is true that the gastrointestinal tract has more neurons and serotonin receptors than our actual brain. This is why the gastrointestinal tract is often called the second brain. How are the second brain and the brain connected? The hypothesis is through the vagus nerve, but the story is still unfolding.

The whole picture may be even more intricate and beautiful, a symphony of interplaying neurotransmitters and our resident gut bacteria and what we eat. A study in Belgium found that people with Major Depressive Disorder were consistently missing two strains of gut bacteria, Coprococcus and Dialister. Of course it is unknown if the missing gut bacteria caused the plummet in mood or if they are the effect of depression, but the finding was interesting and consistent in the study (the findings of the missing gut bacteria were replicated in Belgians and again in a Dutch population). Coprococcus was found to have a pathway linked to dopamine production, a key neurotransmitter linked to mood. In Switzerland, there is a trial underway to use FMT (fecal microbiota transplants) to see if depression can be reversed.

Commercially, there are several companies that will perform FMT for a fee for anything from autism, to Parkinson’s to SIBO (small intestine bacterial overgrowth). Even though the science to prove the efficacy is in its infancy, you can easily get a stranger’s microbiome with a few clicks on the internet.

What about what we eat? Well since we have different bacteria, we can “tolerate” different foods. Being a plant-based physician myself, I do believe that eating a variety of plants (even if you do eat meat, fish, eggs and dairy) is a great way to increase the biodiversity of your gut bacteria. Plants are great prebiotics and feed the bacteria we have, and fermented plant products are great probiotics. The exception is if one has bacterial overgrowth in the small bowel where there are not supposed to be much bacteria (SIBO), in which case the gut moves too slowly and the overgrowth occurs. Add- ing probiotic foods would make the problem worse until it is known what is causing the decreased gut motility and SIBO. Subclinical hypothyroidism and other hormonal issues are often the culprit and it is good to have a team of doctors on the case. Diet wise, a simple diet is introduced with easy to digest pureed fruit and cooked vegetables. Each week or so one may advance the diet and see how the gut responds.

Besides eating plants, one can adhere to a whole food and unprocessed diet as much as possible for good results in mood. A study last year in Molecular Psychiatry found an observational link in those who avoided a pro-inflammatory diet and their mood. Another recent study looked at an “antidepressant food score” and spinach scored the highest, with plant antidepressant foods scoring much higher on their scale than animal antidepressant foods. The score was calculated by looking at 12 nutrients which met the level of “evidence criteria” and were considered “antidepressant nutrients.” These were folate, iron, long chain omega-3 fatty acids (EPA, DHA), magnesium, potassium, selenium, thiamine, vitamin A, vitamin B6, vitamin B12, vitamin C, and zinc.

As the picture evolves, we will see more clearly how mood and food and our host gut microbiome are intertwined. Until then, it is probably best to eat the rainbow, listen to your body and stay tuned. 1

References:

Valles-Colomer, M., Falony, G., Darzi, Y. et al. The neuroactive potential of the human gut microbiota in quality of life and depression. Nat Microbiol 4, 623–632 (2019).

Mol Psychiatry. 2019; 24(7): 965–986. Published online 2018 Sep 26. doi: 10.1038/ s41380-018-0237-8 PMCID: PMC6755986 PMID: 30254236

World J Psychiatry. 2018 Sep 20; 8(3): 97–104. Published online 2018 Sep 20. doi: 10.5498/wjp.v8.i3.97 PMCID: PMC6147775 PMID: 30254980

Physician

Moms Group

Written by Kaylie Dudelson

Hala Sabry D.O., M.B.A, is a full-time Emergency Medicine physician and mother of five young children. She is also the founder of a Facebook support group called “Physician Moms Group” or PMG for short. This grassroots support group is the first of its kind to provide physicians, that are also moms, the network that helps them overcome their real world problems. PMG presently has 71,000 members and has just held their first annual family convention in San Antonio, Texas.

But PMG wasn’t always a large group of thousands of followers. It began as a group of 20 of Sabry’s friends, from whom she wanted to get advice. At this point, with already 3 children all under eighteen months, she sat down and thought, “Well, I still have all these school loans and my investment of working has not paid off.” She was snubbed for a promo- tion that she knew she deserved and was next in line for. But when she asked why she did not receive it, Sabry was told by her boss “you didn’t do anything wrong, but you just became a mom. Don’t you want to be a mom?” She said, “but the message I heard was, ‘You’re only going to be a good mom, like you can’t be a good doctor. You chose your path’.”

This caught her off guard. “I felt like I was given an ultimatum. My ultimatum was, you’re either a doctor or you’re a mom. You can’t do half of each. And you can’t do anything else. So, I wanted to quit medicine because I felt like I had to.”

This was the question that caused her to turn to Facebook to see if there was anyone that had similar experiences, but none of the mom groups that she found were niche enough. She stated, “So I made this group all in one night. I texted a friend and said, ‘Hey I’m going to make this group.’ I’m going to put out my first question. It’s a very vulnerable moment for me because I’m very much admitting that I don’t know how to handle anything right now, and all I want you to do is support me.” She was hoping for a train of support on her one question, not thinking about any further questions.

Yet, the support that she desperately desired grew. The impact of the group made her realize the necessity of support groups, especially for women in the medical field. The women in PMG began to create close bonds with one another as they discussed topics such as the guilt they feel when they spend more time with patients rather than their own children. She recounts how some of her online friends became real life friends. She said, “these friends, some of whom I had not met at the time, had reached out and made a lot of effort to support me in real life. And so those types of friendships are really strong.”

On the PMG Facebook group, all points of discussion are welcomed. The women opened up about difficult times in their lives as well as discussed subjects that are normally avoided, like politics. The government is changing healthcare and other regulations that affect physicians and patients alike. Sabry describes the physician’s job to include educating and to be educated on such topics because it can help the physician understand the patient. She explains “part of our role as physicians is to teach our patients. We’re teachers first. If we can’t even understand the situations that our patients are in, how can we adequately serve them?”

These types of discussions in the group help create growth and allow people to understand different arguments. Having several difficult discussions plaguing like minded individuals, who are going through the same challenges, was the reason why they needed a conference. They decided to actually meet in person in order to see and meet the people who they have had various difficult conversations with and have supported for years. She elaborated and said, “While you can be really mad about something online, maybe you form a relationship with that person in real life and you realize that there’s a certain amount of grace, humility, forgiveness, patience, tolerance, all these things that we learn in social structure to have.”

The first annual PMG convention was held February 14-16 at La Cantera Resort and Spa in San Antonio, Texas. The theme of the convention was: “It’s a Family Affair.” “I don’t want anyone to ever feel like they have to choose their family or their career. Ever. And I feel that this conference really speaks to that.” Sabry stated. It allowed the moms who were at the conference to listen to various distinguished speakers and connect with one another on a personal level while leaving their kids in a daycare-esque group called the Kid’s Track, which was run by PMG. The Kid’s Track is, “Not only child care, but they’re actually learning. And they’re learning from members of our community. They’re learning how to suture, they’re learning how to splint, they’re learning basic life support, first aid, [and] they’re doing yoga in there right now,” Sabry explained. With the Kid’s Track, the moms could have their fun, knowing that their children were in good hands, learning, and enjoying themselves as well. After the success of their first annual conference, PMG is already planning their next convention, which will be held next year in Kiawah Island, South Carolina, where the theme will be to “Bridge Communities” to host other online communities who have yet to have regular in-person meetings. Sabry feels that the success of the PMG conference should be shared and the connection to other online communities is one way to unite physicians in today’s healthcare landscape.

They expect to be able to continue helping women build a network and spread necessary information to other women in the medical profession. Ultimately, Sabry wants to specifically spread three important messages since she now has a voice in the community. The first is, “Do no harm” which is an oath all doctors take. Sabry believes, “By not listening to each other about medical needs and social needs in society, we [physicians] are doing more harm.” The second point is, “See one, do one, teach one.” By this she means that starting from training days, physicians are observing and learning, and to solidify the knowledge, they teach it to another person. She connects this with support systems, and how groups allow people to keep learning from others. Finally, the third point is that “the physician community is very fragile, there are a lot of issues that are facing us, whether it is with policy with the government changing healthcare, whether it is legislation on physicians that is leading to burnout like in lawsuit cases and in liability, or the concerns that we have about physicians being the lead of the health team and making sure that true in depth pathophysiology of patient care is the primary care of clinical medicine.” Since the system is overwhelmed, there are fewer individuals graduating medical school and less getting into residency. She continued, “[the medical society is] really doing a disservice because the physicians should be the lead of heath teams because they know the most medicine. It’s not that they know just enough to get by, they know it. And we need to be able to continuously train physicians to be the leads of these healthcare teams. We owe it to our professions, we owe it to our patients, and I wouldn’t want anything less than that for my children. .” With these closing statements, Sabry clearly expressed her passion for the community while revealing why she believes an open network of different voices is necessary in the medical community. PMG is steadily growing and is allowing physicians who are also moms to have an outlet to express themselves while receiving support from others.1