According to Dr Vivette Glover, Director of the Foetal and Neonatal Stress and Research Centre: “at any one time during pregnancy, one in every ten women will suffer with depression and around one in every thirty will be depressed both during pregnancy and the postnatal period.”

It is not yet understood exactly what causes the symptoms associated with depression during and after pregnancy. However, several factors play a significant role in how the body deals with stress:

large changes that the body undergoes due to the demands of the growing foetus

breastfeeding

potential sleep deprivation

It is during this period of time that our bodies require more nourishment from food than ever and it can also be at exactly this time when we perhaps struggle to prioritise nutrition due to lack of energy, loss of appetite or sickness. 

Pre and Post-Natal Depression are both complex conditions that can have multifactorial underlying drivers, including genetic and environmental influences. These are currently poorly investigated and the gold standard of treatment is often medication to help stabilise mood. Whilst SSRIs and other types of antidepressants have proven to be helpful for many, they do not address potential causes or drivers of poor mental health and can often mask symptoms. Medication for depression (ie antidepressants) are also not regularly recommended during pregnancy, which is why being more mindful of nutrition and lifestyle habits can be a safer option for you and your baby. There are some natural, evidence-based steps you can take to help support optimal mental wellbeing:

Eat Foods to Support Energy Depletion:

Common issues such as poor sleep during pregnancy and sleep deprivation following the birth can often heighten cravings for stimulants and sugary foods, which may seem like a good option for quick sources of energy, however, these foods can often cause further issues with energy and lead to fatigue and low mood. Eating foods that are high in refined sugar and refined grains such as commercial white bread, pastries, cakes and biscuits, give us an unsustainable source of energy. 

The brain is a very metabolically active organ; despite it only being 7% of the body’s weight, it can take up to 20% of the body’s metabolic needs, meaning that it is very energy hungry. This is why it is important to nourish the brain with foods that are nutrient rich, providing the body the building blocks to produce neurotransmitters, as well as a sustainable source of energy. The best options are fresh, unprocessed foods such as wholegrains (brown bread, brown rice, quinoa, rye and oats), pulses, vegetables, good quality sources of protein (meat, poultry and fish) and healthy fats such as those found in olive oil, coconut oil, avocados and oily fish. 

Just like throughout pregnancy, nutritional needs after birth, especially if breastfeeding, are incredibly important. The healthier the diet, the easier it will be to sustain the energy needed to take care of a newborn. Research shows that a breastfeeding mother needs an extra 300-500 calories a day, from food that is rich in the right macro and micronutrients to nourish both mother and baby. For example, nutrients such as B vitamins have shown to be important in supporting the mother in ensuring she has enough energy to meet the demands of lactation. These nutrients can be found in green leafy vegetables, wholegrains and good sources of animal protein. 

Protect yourself from Oxidative Stress:

Oxidative stress refers to a biochemical process that occurs as a result of an accumulative everyday exposure to toxic burdens. These include such things as chemicals in cosmetics, furniture, paints, cars, and pollution.

Our body has its own way of armouring itself from the damage that exposure to toxins can create through its production of endogenous antioxidants. This is nature’s way of neutralising oxidative stress. Although we have our own production of these wonder molecules, when we are continuously overloaded with toxins in our environment and have problems detoxifying, the liver can become overwhelmed.

Research shows that over time oxidative stress can lead to an increase in inflammatory molecules such as cytokines, which have been shown to correlate with depression. This is why it is important to have a high intake of nutrients that support the liver in metabolising and removing toxins from the body, as well as regulating the inflammatory response.

There are a few things we can change in our diet to support this area, for example eating foods such as the cruciferous family of vegetables which includes kale, cauliflower, broccoli and cabbage. These are particularly effective at supporting the liver in ushering out toxins as they all share an antioxidant compound called indole-3 Carbinol, which plays an important role in liver health. In addition, bitter greens such as collard greens, rocket, chicory and swiss chard are also great for supporting the liver’s own antioxidant defence system.

Increase intake of Omega-3 Fatty Acids:

During pregnancy and after pregnancy there is often a concern for the potential depletion of the maternal nutrient reservoir due to the needs of the growing foetus.

A nutrient that is particularly important for mental wellbeing and is also essential for the growth of the foetus’s brain, is DHA. This is an omega 3 fatty acid that is found in oily fish and is the primary structural component of brain tissue. It also plays a crucial role in the maintenance of brain cells and neurotransmitter metabolism. Our body can also convert plant sources of omegas 3’s into DHA, such as those found in flaxseeds or chia seeds into DHA, but the conversion can often very poor.

Deficiency in this nutrient during pregnancy is common, mainly due to higher requirements during foetal growth, which can lead to depletion. Another contributor is a lack of seafood intake (the most bioavailable source of DHA) due to concerns of mercury levels in fish during pregnancy.

DHA plays an important role in neurotransmitter metabolism, so deficiency in this nutrient has been correlated to symptoms of depression during pregnancy.

In order to support your intake of omega 3, aim to have 3 portions of oily fish a week from sources that are low in mercury. These are mainly small fish that have a short life-span such as sardines, mackerel and herring.

If you are vegetarian or vegan, although omega 3 is less readily available, it is still possible to get this nutrient from your diet through flax seeds, chia seeds, walnuts and seaweed.

If you feel you may not be getting enough through your diet, you may want to consider using a good quality fish oil supplement (or algae based supplement if vegan) as an option. With fish oils, aim to choose a supplement that has been filtered for heavy metals and other pollutants to make sure you’re getting the full benefits of the omega 3 oils.

Exercise and Personalised Nutritional Therapy:

In addition to diet, there are many other things you can also do to alleviate depression in pregnancy related to lifestyle, such as stress management through mindfulness or gentle movement such as pre or post natal yoga, which have both shown to be incredibly helpful in encouraging mental wellbeing. If you feel you need extra support, personalised nutritional therapy can be very helpful as there can often be other drivers such as nutrient deficiencies and digestive complaints that can play a significant role in mental health and will need to be addressed in a way that is tailored to the individual. 

BANT (British Association for Applied Nutrition and Nutritional Therapy), have a large network of therapists you can use to find a therapist suitable for you.For wider help and information, you might want to contact the PANDAS Foundation, a charity who offer pre and post natal advice and support.

Stress is part and parcel of life and in balance can actually be healthy. It keeps us motivated, helps us get out of bed in the morning and can be a good warning sign that things aren’t working for us in our current everyday lives, and encourages us to make positive changes. 

However, what happens when we simply can’t turn that switch off and stress turns into something chronic? 

Our body has a very efficient way of dealing with stress. We release hormones like cortisol and adrenaline, which raise our blood pressure and heart rate and shift glucose from the liver into our bloodstream, ready for our muscles to use. This is also known as the “flight or fight” response in our nervous system, which gears us up for exactly that: fight or flight. It’s the opposite to the “rest and digest”, which is associated with metabolising and assimilating the nutrients in the food we eat, as well as regenerating and repairing cells. 

Our prehistoric bodies aren’t made for chronic stress

Despite this intelligent stress response, our prehistoric bodies are not used to being in a constant state of stress, which depletes our body of vital nutrients, such as B vitamins and magnesium, that are necessary for optimal health. The constant elevation of cortisol and adrenaline, our body’s stress hormones, can lead to prolonged levels of inflammation, as well as weakening of the immune system’s defences. 

Poor dietary habits are also sources of stress

In addition, our nutrition and diet also contributes to increased stress levels and illness. While simple carbohydrates, sugar and caffeine give us energy in the short term, in the longer term they lead to constant adrenal overload, i.e stress. As a consequence of chronic stress and poor dietary choices, a growing number of people are suffering from anxiety disorders, panic attacks, low mood, insomnia, chronic fatigue and stress-related weight gain.  

How stressed are you?

There are some key dietary strategies we recommend anyone undergoing chronic stress tries. But first, we have a simple test you can take for you to get an idea of your stress levels:

• Is your energy less now than it used to be?
• Do you feel guilty when relaxing?
• Do you have a persistent need for achievement?
• Are you unclear about your goals in life?
• Are you especially competitive?
• Do you work harder than most people?
• Do you become angry easily?
• Do challenging situations trigger anxiety or panic?
• Do you find it hard to think straight under pressure?
• Do you often try to do two or three tasks simultaneously?
• Do you find it hard to relax or switch off?
• Do you avoid exercise because you feel too tired?
• Do you get impatient if people or situations hold you up?
• Do you have difficulty getting to sleep, or staying asleep?
• Do you wake up feeling tired?

If you answer yes to five or more, that’s a fair indication you’re highly stressed. The higher your score, the greater the negative impact of stress on your life. 

We know that chronic stress has dire long-term health consequences, increasing risk for heart disease by five times and doubling the risk for obesity, dementia and diabetes. 

So it’s not something we can ignore or let take over our lives. 

Dietary recommendations to improve stress management

There are also some simple dietary changes you can follow to support stress levels; of upmost importance is to eat correctly in order to keep blood sugar levels balanced, as dips can trigger production of stress hormones and lead to an energy deficit in the brain.

The brain requires steady blood sugar levels

The human brain weighs just 2% of an average body’s weight, however it is the organ that demands the most energy in the human body. The brain’s preferred source of energy is glucose, a simple sugar that most of our food gets broken down into to create a sort of energy currency in our body. 

A whole 20% of the glucose traveling round our body gets directed to the brain and its functions. 

So now you can imagine why our brain is so sensitive to fluctuations in our blood sugar levels, and this gets even worse when chronic stress is in the picture. 

Chronically elevated cortisol levels due to poorly managed stress, triggers an increase in blood sugar levels as our body prepares itself for “fight or flight”. This is why it’s even more important to stabilise our blood sugar levels when we are chronically stressed to avoid further anxiety and mood swings. 

Below are a few top tips to eat for less stress and to balance blood sugar:

• Eat three meals a day and never skip breakfast – This helps you keep your blood sugar even. Blood sugar dips either from not eating or as a rebound after eating something too sweet or starchy, which triggers adrenaline release, and hence stress.
• Eat protein with every meal – For example, eggs, plain natural yoghurt, smoked salmon or kippers with your breakfast; and meat, fish, eggs, dairy foods, or pulses combined with wholegrains for your lunch and supper. This will help to sustain your energy levels.
• Choose slow-releasing carbohydrates rather than refined foods Opt for brown rice, whole grain bread, quinoa and oatcakes (avoid processed and white equivalents)
• Reduce your dependence on stimulants – ie. coffee, tea, energy drinks and cigarettes. Rather than giving you energy, these deplete energy over time, and contribute to blood sugar imbalances.
• Snack preemptively – if you know you have an energy dip before lunch and around 4pm, have a snack mid-morning and again mid-afternoon. Avoid sugar-loaded treats and instead opt for energy-sustaining fresh fruit and nuts, an oatcake with some cheese, nut butter, paté or hummus.

We hope you find these tips useful. However, if you’re experiencing frequent panic attacks, chronic anxiety and depression, it may be worth seeking some personalised support with an integrative mental health practitioner that can also advise you on your diet. 

Please head to our ‘Seeking Help’ page for more information on organisations and networks you can reach out to. 

Methylation and mental health are intricately related. We take a deeper look into the association and why it is important

What is methylation? 

Methylation has been a buzzword in the integrative health sphere for some time now. This is unsurprising considering its importance to our overall health and wellbeing. You may have heard of it before – or even googled it… Were you then promptly turned off by it after just one glance at its complexity?

We don’t blame you, understanding methylation is not for the faint-hearted. 

However, let us break it down for you into bite sized chunks. Hopefully you can finally make sense of it and apply this knowledge to your everyday life. 

Think of it as a biological switch

Methylation is a critical biochemical process that happens billions of times in every single cell of the human body. It’s responsible for a vast range of biological functions such as: 

Detoxification
DNA expression
Neurotransmitter production
Hormone regulation

Whilst it can be complex in nature, the process of methylation simply entails the transfer of four atoms: one carbon atom and three hydrogen atoms. These are transferred from one substance to another.  

Let’s say that methylation is a type of biological switch that turns on and off to help keep our health in check. 

How does methylation impact mental health?

Whilst we know that methylation plays an intrinsic role in so many important functions in the body, for the purpose of this article, we will narrow the information down to its role in mental wellbeing and brain health. 

Put simply, methylation helps us make neurotransmitters, such as serotonin, dopamine, adrenaline, norepinephrine and melatonin. 

Methylation does this in a number of ways. It helps:

Convert tryptophan (building block for serotonin) to 5-HTP (precursor to serotonin) 
Transport dopamine, norepinephrine and adrenaline
Convert norepinephrine to adrenaline (important for focus and attention)
Lastly, convert serotonin to melatonin (sleep neurohormone) 

So as you can see, it’s pretty vital to a balanced mood and overall brain health. 

What impacts methylation? 

Unfortunately there are many things that can negatively impact methylation, such as our diet, exposure to environmental toxins, genetic factors and lifestyle habits. 

Let’s look at this in a little more detail. 

Anything that triggers oxidative stress can have a negative effect on methylation

Oxidative stress is a natural biological process that’s usually offset by our body’s own endogenous antioxidant production. But when there’s an imbalance between the two, and factors in our environment generating oxidative stress are tipping the scale in their favour, that’s when we can see prolonged inflammation and problems with methylation. 

What specific environmental factors can impact methylation?

Our modern environment is plagued with reactive oxygen species ROS that generate oxidative stress in the body. Key examples are environmental endocrine disruptors, like PCBs, herbicides, pesticides and plastisizers, as well as air pollution. 

Whilst we can’t necessarily fully control these aspects in our environment, we can control our defence against them, as well as making wise dietary choices that will have less of these substances in them. 

But first, let’s talk about what else can impact methylation.

Dietary factors and methylation

What you eat can impact how well you methylate – especially intake of processed foods and sugars, which has been shown to play a negative role in methylation.

Perhaps unsurprisingly, research shows that eating a wholefood diet that includes wholemeal cereals, fish, legumes, fruits and vegetables can have a positive effect on methylation. 

Aside from dietary factors, there are a few nutrients that play a critical role in methylation. 

Folate

Perhaps the most important nutrient is folate or B9. Methylation is almost entirely dependent on the availability of folate in the diet. It uses this nutrient to create the methyl donors – SAMe and methionine – to spark enzymatic reactions that are required for neurotransmitter production and transport. 

A large body of research confirms that folate deficiency – something that is incredibly common – is frequently seen in those with depression, and is remediated with the supplementation of this nutrient.

When we consider the role that optimal methylation plays in producing serotonin and other neurotransmitters, it’s easy to see why folate is so important. 

Be mindful with folic acid

Many are drawn to supplementing folate in the form of folic acid – the synthetic version of this nutrient. You can often find folic acid in fortified foods such as breakfast cereals and breads. 

However, what little people realise is that this version of folate needs to be converted in the body to l-methylfolate and many people lack the ability to do this efficiently due to gene variations. 

This means the body is unable to utilise the folic acid properly. 

We go into gene variants in a little more depth further down, so hold on for more information. 

Where can we get folate in our diet? 

Green leafy vegetables and legumes are perhaps the most rich sources of folate, so be sure to be getting these in your diet frequently.  

B12

Whereas folate is important to initiate the methylation cycle, B12 is required for the activation of folate from dietary folate to  5-methyltetrahydrofolate, so that it can go on to create the methyl groups – SAMe and methionine.  

If there isn’t enough B12 in the diet, folate can get stuck in the cycle, which halts methylation. 

Where can we get B12 in our diet? 

B12 is a nutrient that’s found in animal foods, such as meats, fishes, eggs, poultry and dairy products. This means that if you’re vegan or vegetarian, you will likely need to supplement your B12 and consider eating fortified foods, such as plant milks. 

Choline

Choline plays an important role in various junctions in the methylation cycle. It is widely known that when folate is low, the body uses choline as its back up methyl donor to help keep methylation ticking along. 

Choline helps with activation of folate, as well as the recycling of homocysteine to methionine – a critical step in methylation. 

Having high homocysteine is a key way of indicating whether your methylation is struggling and whether this recycling process isn’t functioning properly. 

What’s wrong with homocysteine?

We don’t want accumulating levels of homocysteine as it is a neurotoxin that has been linked to psychiatric disorders such as depression, schizophrenia, bipolar and Alzheimer’s disease. 

This is why if mental health is a concern, testing for homocysteine is a great way to find out whether you may have issues methylating. 

Here’s a little more information on testing and further ways to check your methylation.

Testing methylation

In addition to homocysteine, which is explained in further detail below, you can also take a DNA test to see whether you have any mutations on the MTHFR gene – the primary gene that is responsible for folate activation and homocysteine recycling – both of which are necessary for optimal methylation and therefore neurotransmitter production.

Testing for MTHFR

Variants or mutations on the MTHFR gene are inherited from your parents and can either be heterozygous (meaning you have one mutation) or homozygous (two mutations). 

It’s well known that having a homozygous mutation is more likely to cause health problems and having a heterozygous mutation is unlikely to cause issues. 

Common variants are:

C677T 
A1298C

Testing for these variants is done by a simple saliva test and is usually done privately. Here in the UK, there are various providers such as Lifecode GX, however, if you’re not based in the UK there are likely many more providers globally. 

Testing homocysteine

Testing homocysteine levels is a little more invasive, as it requires a blood draw. 

Bear in mind that levels are not static and can change based on how well you’re methylating, as well as certain dietary factors, such as caffeine and alcohol consumption, which have been shown in some cases to tax methylation.

You can test your homocysteine here at Food for the Brain. Find details in our easy-to-order and simple pin-prick test here.  

How do we optimise methylation?

As well as eating a wholefood diet that is devoid of sugar and processed foods, if you suspect methylation may be an issue for you, it’s important to take the environmental factors listed above into consideration. 

In order to avoid toxins and pollutants you can:

Eat organic produce
Drink filtered water
Buy toxin free cosmetics that don’t include typical endocrine disruptors such as parabens, benzophenones, bisphenols, and phthalates
Avoid plastics (bottled water, cling film, plastic tupperware etc)
If you smoke, stop 

Work with a nutritionist

Working with a registered nutritionist is crucial for supporting the right supplementation programme in accordance to individual needs. 

You can find a network of nutrition professionals on BANT, as well as Nutritionist Resource. 

Key takeaway: genes load the gun, but it’s the environment that pulls the trigger 

Eating a healthy, balanced diet, as well as engaging in healthy lifestyle practices will always trump and cannot be replaced by supplements. 

Your environment includes your diet, lifestyle, sleep, exposure to toxins, relationships, where you live and so on. These are, for the most part, modifiable, and all play an essential role in how genes like MTHFR are expressed.  

This is good news as it means that you are in control of your health and can start taking the right steps today to help support your methylation and overall brain health and mental wellbeing. 

Enjoyed this article? Check out our blog for other deep dives into various aspects of nutrition, lifestyle and brain health. 

One in three of us are addicted

According to the charity Action on Addiction, one in three of us are addicted to something, whether it be a substance such as caffeine, cocaine or alcohol, or whether it is in the grips of a particular habit that is preventing someone from living their lives in the way in which they’d like.  Addiction emcompasses a wide range of behaviours and dependencies and can range from substance misuse to an addiction to gambling, shopping or food. 

In the US, research carried out over a 12 month period, demonstrated that it was quite plausible that 47% of the U.S. adult population suffers from maladaptive signs of an addictive disorder. Despite the variations of addictions and the behaviours that are entailed, it is increasingly recognised that common underlying neurochemical imbalances can be found amongst all of them. 

It’s down to an addiction to ‘feel-good’ neurochemicals

The addicted brain has essentially become dependent on a substance or habit to produce feel-good chemicals; neurotransmitters that are associated with feelings of reward, pleasure, satisfaction and relief. When neurotransmitter balance in the brain is out of kilter due to either genetics, chronic stress or a poor diet, for example, we are more susceptible to turning to substances such as alcohol or caffeine. These substances bring us back to balance, as our brain instinctively craves what we are deficient in. In order to reach a more comfortable state, vulnerable individuals attempt to continuously manipulate their neurobiological circuitry by repeatedly using substances such as a drug or engaging in a behaviour such as gambling. The challenge with this is that these are often substances or habits that can leave us in a vicious cycle of needing more to produce the same effect. 

How we become addicted

A simple way of describing this is with caffeine, for example. A large majority of us struggle to start our day without our first cup of coffee in the morning. This is often related to having a poor circadian rhythm, whereby cortisol (a hormone that helps us wake up), which is normally supposed to peak in the morning, is abnormally low. Caffeine helps to stimulate the release of cortisol, adrenaline and the feel-good neurotransmitter dopamine. All together, the effect helps to enliven, motivate and stimulate us to get up and go. As our brain strives for balance after drinking a cup of coffee, or any other substance that’s mood-altering, the receptors to the neurotransmitters that have been stimulated, consequently dampen in order to avoid over-saturating our brain. 

We become ‘reward deficient’ 

This means that we begin to build tolerance and therefore need increasing amounts of the chosen substance to produce the same rewarding effects. Eventually, this can lead us to what has been labelled as ‘reward deficient’, whereby our brain has become dependent on a substance or a habit to produce neurochemicals that lead to the ‘reward’ that it is seeking, which are in most cases feelings of pleasure, stimulation and satisfaction. 

Why it’s so difficult to give up

Giving up an addiction can be incredibly difficult, as the dependency is hardwired into the limbic system, an area of the brain that is only concerned with meeting our basic needs and survival. In addiction, obtaining the substance or engaging in a behaviour is a matter of survival to this part of the brain. The symptoms caused by abstinence, when the addictive substance or habit is removed, can be debilitating and can include anxiety, fatigue, hypersensitivity to stress or pain, problems sleeping and extreme mood swings.  These symptoms can continue for long periods of time and can therefore be a negative influence in relapse. 

Nutrition, alongside lifestyle changes such as exercise, improved sleep patterns and relieving stress, can play an essential role in helping to support the brain back to health. By supporting the optimal functioning of brain cells and neural networks, as well as helping to stimulate the brain’s intrinsic regenerative functions, we can help to attenuate cravings and therefore prevent the chance of relapse. 

Here are  4 dietary tools to support your brain:

1. Blood sugar rollercoaster = cravings = relapse 

Eating a diet low in glycemic load can be an effective nutrition tool in reducing cravings and supporting brain and body health. This means eating foods that will have as little impact on blood sugar levels as possible, helping to keep them stabilised, which can have a positive impact on stress levels. This is due to the intimate relationship between blood sugar, cortisol and adrenaline – our stress hormones. When we eat foods high in glycemic load, sugar is released too quickly into our blood and insulin levels peak in order to rapidly remove the sugar from the blood into our cells. The result is that we are then left with lower than necessary blood sugar levels, which can lead to symptoms such as fatigue, mood swings, irritability, headaches and dizziness. Cortisol and adrenaline release are also stimulated, as they trigger the mobilisation of glucose from storage into the blood for use as quick energy. As you can see, these kinds of symptoms are not so different from abstinence symptoms, which can leave us vulnerable to relapse. 

We also know that neurotransmitter production and transmission can only happen when there is a consistent supply of glucose to the brain, which is provided by the food that we eat. When blood sugar levels are rollercoastering due to a diet high in sugars, refined carbohydrates and processed foods, neurotransmitter transmission cannot happen optimally, leaving the brain deficient in inhibitory neurotransmitters that are essential for preventing anxiety, panic and irritability. 

How to eat a low GL diet

In order to eat a low glycemic load diet, it is important to eat foods that will release sugar slowly from food. Switching from refined grains such as white bread and white rice to wholemeal is important, as well as avoiding processed foods such as biscuits, cakes, fizzy drinks, confectionary and even seemingly healthy foods such as fruit juices. These do not provide the body with sustainable sources of energy, as blood sugar levels rise and fall rapidly, leaving us susceptible to cravings.

Instead, replacing these foods with good sources of protein, fat and fibre with every meal will stabilise blood sugar levels and therefore help to avoid the symptoms associated with blood sugar crashes. Lean meats, oily fish, pulses and nuts and seeds and avocados are all examples of healthy sources of protein and fat.

It’s all about the prebiotics

We’ve all heard about probiotics, but what about prebiotics? The gut contains approximately a trillion bacteria of varying strains, which thrive on the fibre from the food that you eat, or in other words prebiotics. This helps keep them nourished and continue performing all the wonderful things that they do, one of which is producing neurochemicals that literally ‘speak’ to our brain and help keep your brain healthy.

Which foods provide good sources of probiotics? 

Foods that are rich in fibre, such as wholemeal grains, root vegetables, pulses, green leafy vegetables, nuts and seeds, are all examples of foods that we can increase on to help nourish our gut bacteria and therefore our brain. In addition to supporting gut bacteria, these foods also help to stabilise blood sugar levels, so it’s a win-win conclusion.

Latest research is showing just how important gut bacteria composition is for our mental health. In particular, it’s the metabolites that bacteria produce, such as short chain fatty acids, which can help regulate and prevent neuroinflammation, that are so interesting when looking through the lens of how diet can influence brain health. These short-chain fatty acids, such as butyrate, propionate and acetate help to leverage communication between the gut and the brain, having a direct impact on our neurotransmitters. 

How to increase prebiotics in the diet

Research shows that the average adult is not getting 30g of daily fibre, which is the minimum we need to be consuming for optimal health. Ideally we need more. A quick way of hitting that target is making your meals as colourful as possible with a wide range of plant foods, such as vegetables, legumes, nuts and seeds. Dedicating half of your plate to these foods in variation and rotating them as much as possible, will help you exceed the target of 30g of fibre per day.

3. The brain is dependent on essential fats 

The essential fatty acid, omega 3, can be incredibly therapeutic in helping to optimise the function of our brain cells. Omega 3 is composed of two elements, EPA and DHA, which play an important role in regulating inflammatory responses, as well as nourishing the membrane of our cells. This is the part of our cells that is involved in receiving and transmitting neurotransmitter signals, as well as controlling nutrient intake and waste removal. 

This is important when considering the process of recovery from an addiction, due to the long-term impact that habits such as alcoholism, smoking, food addictions etc. can have on the brain and its ability to maintain optimal neurotransmission. Quite often what can happen in the event of long-term addictions is both a lack of integrity in brain cells and upregulated inflammation, all of which can continue to perpetuate addictive habits and dependency on certain substances. Increasing omega 3 rich foods, will therefore help to provide the brain with the building blocks it needs to repair and thrive. 

Maintaining a healthy ratio between omega 3 and 6

Both omega 3 and omega 6 are essential in the diet as we cannot manufacture them in our body. Our brain needs both for optimal functioning, however, they need to be in the right ratio. 

Anthropological evidence of hunter-gatherer diets suggests that our ancestors evolved on a diet that was roughly 1:1, while the ratio today is actually 16:1 (omega 6 : omega 3). Our intake of omega 6 diets has increased by incredible amounts due to the industrialization of agriculture and the introduction of seed oils and grains in our diet. 

Why is this a problem? 

Omega 6 is pro-inflammatory. Whilst we need inflammation – it’s necessary for tissue repair and for fighting against infections – too much of it can cause problems. Especially for the brain. Increased neuroinflammation is the hallmark of poor mental health and symptoms of low mood, brain fog and anxiety. This is why it’s key to support the brain by increasing omega 3 rich foods and avoiding seed oils such as rapeseed and sunflower oil.

How to increase omega 3 foods

The best sources of omega 3 are small oily fish such as sardines, anchovies, mackerel and herring. Enjoying these sources of omega 3 foods in your diet 3-4 times a week helps to provide the brain and body with optimal levels of omega 3. 

If you’re vegetarian, plant-based sources include walnuts, flaxseeds, chia seeds and hemp seeds. However, we recommend eating these foods on a daily basis as levels of omega 3 are much lower and only contain the precursor form of omega 3, which then needs to be converted in the body through an enzymatic process.

4. Consider amino acid therapy

Amino acids – the building blocks of protein – also provide the building blocks for neurotransmitters, as well as helping to support the cells in our brain and their energy-producing pathways. Depending on the substance or habit to which someone is addicted, supplementing with the right nutrients to address certain imbalances can be effective in improving abstinence symptoms, without causing side effects or dependency on medication. 

Amino acids can help restore brain chemistry

Amino acid therapy, whereby specific amino acids are supplemented to help restore normal brain chemistry, has been shown to be an effective way of helping the brain to recover from its ‘reward deficiency’ and rebuild its own built in mechanism for producing a natural high. Every cell in our body is dependent on amino acids, which are the components that make up proteins, to ensure reproduction and growth. Amino acid therapy has shown to help increase receptor sensitivity to neurotransmitters such as GABA, serotonin and dopamine, as well as improve glucose metabolism, which also helps to support energy-production pathways in the cells. 

Working with a professional

However, the process of figuring out the right combination of amino acids is a complicated one. This is why it is important to work with a specialist in this area that is able to assess the symptoms and analyse test results to build the right personalised nutrition and supplement programme for an individual. If you’re interested in working with a professional practitioner in this area that can guide you through a tailor-made nutritional programme to suit your needs, you can search online via BANT (British Association for Applied Nutrition and Nutritional Therapy). 

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Despite the festivities and joy that Christmas celebrations can bring for some, for many, it can be a particularly painful time with heightened feelings of loneliness and despair. This may be especially true for those who are isolated or disconnected from their loved ones. With the extra pressures that this year brings, it’s important to have some strategies in place to help us find a sense of connection. 

An interesting recent study, offers some key information on how the brain is wired to seek social connection as if our survival depended on it, which helps us to understand why many of us feel such despair when we’re lonely. Neuroscientists at the University of Cambridge observed 40 participants in complete isolation for 10 hours, after which they were shown images of people socialising or playing sport. In response to these images, neurons in the midbrain – which is the part of the brain that is responsible for producing dopamine, our reward neurotransmitter – were stimulated. Interestingly, the same thing happened when these same participants – on a different day – were made to fast for 10 hours and then shown images of appetising food, like pizza and cake. This demonstrates how when we are lonely, we crave social connection in the same way that we crave food when we’re hungry. 

Connection to others is just as much of a necessity to survive as it is to eat, and it’s not the first time that science is showing this. For example, we know that loneliness is a significant risk factor for poorer cognitive health, as well as depression and mortality. So, in light of this, and with the added pressures of the pandemic, how can we nurture our connection with

others to help us thrive throughout the festive season? Here are a few tips that can help to boost our sense of connectedness:

1. Review which kinds of social interactions energise you the most 

This may be a time to reflect on which relationships/social circles you value the most and which ones may be leaving you a little drained. It is possible to feel lonely or disconnected, even when you’re with friends or family. Once you’ve determined those that you value the most, find time to nurture those connections away from distractions, such as phones or TV. Getting out in nature by finding a new park or green space you’ve never been to before and arranging a walk with a friend, or cooking a new recipe with your loved one and having a romantic dinner. The list is endless, but the most important thing is that it works for you. 

2. Find a volunteering opportunity

Science shows that altruistic behaviour, kindness and compassion, increase levels of endorphins and oxytocin, as well as creating new neural connections. Find a local food bank distribution venue or another cause that you resonate with where you can meet new people and help support others. 

3. Get creative

Getting involved in creative expression of any kind, from drawing and cooking, to gardening or dancing, can help to increase a sense of connection to ourselves and others. For example, making something creative with a friend or giving something creative as a gift, can be very therapeutic and rewarding, and has the added bonus of not requiring technology.

Final words…

It’s worth reiterating that loneliness can be a subjective experience, meaning that we can still be lonely despite having many loved ones around us. This highlights the need to take time to reflect and identify what makes each of us as individuals feel connected. 

Estimated reading time: 6 mins

Since 2003, November has been coined ‘Movember’ by the Movember Foundation, originally a campaign that was launched to tackle issues related to prostate cancer and now raising awareness and funds for the biggest issues in men’s health, one of which is mental health and suicide. The statistics related to men’s mental health are alarming, according to the latest figures, 3 out of 4 suicides are men and it is the leading cause of death in England and Wales for men aged between 20 and 34 years. This may be of no surprise considering that men are less likely to access psychological therapies than women; only 36% of referrals to IAPT (Increasing Access to Psychological Therapies) are men. In addition, men have measurably lower access to the social support of friends, relatives and community. This indicates that there may be a serious epidemic of men that are going undiagnosed, in comparison to women.

Recovery is possible

Mental health is tough to talk about and many people don’t realise that a diagnosis does not mean you have to live with it for the rest of your life. Recovery is possible. When it comes to the male population, statistics show that they are more at risk of suffering from mental health issues caused by addiction to alcohol or drugs. Specifically, men are nearly three times more likely than women to become alcohol dependent, and are three times as likely to report frequent drug use than women, with more than two thirds of drug-related deaths occurring in men. 

Taking this fact into consideration, and with the knowledge that dietary changes can support addiction recovery, optimise mental wellbeing and potentially reduce the risk of relapse, nutritional therapy may help play a very important role in reducing the risk of suicidality.

Happy brain = happy mind

Targeted dietary changes can be highly effective in supporting mental wellbeing, by preventing cravings for substances such as alcohol and illicit drugs through optimising brain health. It is well-known that the brain uses up more energy than any other organ in our body, consuming about 20% of the body’s energy requirements. This means that it requires a consistent supply of fuel. Even when we may not appear to be using it, such as when we’re sleeping, there is still a high baseline consumption of glucose, which is our body’s main source of fuel. Two thirds of the brain’s energy is used to help neurons – our brain cells – send signals, with the remaining third used for basic housekeeping – or in scientific terms cell-health maintenance. When our brains are healthy, the rest of our body is healthy, plus we also feel great. 

Balance blood sugar levels to prevent cravings

Those with mental health conditions and/or addictions often have issues with blood glucose dysregulation, meaning the brain is getting an inconsistent supply of energy. According to NICE, depression is the most common psychiatric disorder witnessed in the diabetes community and people with diabetes are 3 times more likely to have depression than those that don’t. This indicates that blood sugar control is important when treating depression and other mental health conditions.

A key way to prevent this is by eating foods that are low in glycemic load, meaning they have little impact on your blood sugar levels and are able to supply the brain and body with a consistent source of energy. Foods that are high in glycemic load include; refined grains such as white bread, pastries, baked goods, white rice, desserts, sweets, chocolates, fizzy drinks, alcohol and fruit juices. These are important to avoid and replace with a diet that is rich in vegetables, legumes, whole fruits, healthy fats like olive oil, avocado, nuts and seeds, whole grains such as wholemeal bread and brown rice, and finally good quality protein from eggs, poultry, fish and some red meat. 

Increase the omegas

Another key area to look at is increasing intake of omega 3. This important nutrient is an essential fatty acid that we need to include in our diets as we cannot make it in our body. Omega 3 plays an important role in supporting brain cell structure, nerve conductivity and for regulating inflammation, all of which are important for supporting optimal mental wellbeing and cognitive function. Depression is now being considered by western medicine as a symptom of chronic and systemic inflammation, so much so that anti-inflammatory drugs commonly used for rheumatoid arthritis are now being used successfully in trials to treat depression. Oily fish such as sardines, mackerel, anchovies and herring are great sources of readily available Omega 3. However, it can also be found as alpha-linolenic fatty acid in some nuts and seeds such as flaxseeds, walnuts and chia seeds. These go on to be converted into the omega 3 found in fish and seafood, through enzymes in the body.

Low cholesterol and suicide

Something which is rarely touched upon in mainstream media is the importance of healthy cholesterol levels for mental health. Many believe that cholesterol needs to be kept as low as possible in the body, due to it’s ‘artery-clogging’ properties. However, there is a lot more than meets the eye when it comes to this highly important fat and its various roles in maintaining health in the body and brain. The brain actually stores the highest level of cholesterol in the body, containing approximately 20% of whole body cholesterol. And it’s no wonder that this is the case, since one of cholesterol’s most important functions in the brain is supporting the structure and function of neurons (brain cells), making up part of the outer protective layer of nerves and their cells to help optimise cell signalling and communication. 

Studies have also shown that cholesterol plays a pivotal role in serotonin transmission due to cholesterol’s role in cell membrane structure. Considering this key fact, it makes sense why so many studies have persistently shown an association between low serum cholesterol and major depression/low mood. Aggressive statin medication has unsurprisingly led to reports of increased anxiety, depression and irritability. However, research is still unclear and it is important to highlight that not everyone that takes cholesterol-lowering medications will be predisposed to a mental health condition. 

Based on the knowledge that cholesterol is important for brain function, what can we do to achieve healthy cholesterol levels? 

Well, the two points above on balancing blood sugar levels by eating a diet low in glycemic load, as well as increasing omega 3 intake are important steps, which will help raise HDL cholesterol (this is the cholesterol we want to be nice and high in comparison to the LDL).

However, another key dietary factor to take into consideration, is avoiding trans fats and industrial seed oils, which will have a negative impact on HDL levels, as well as raising LDL levels. This means avoiding seed oils like sunflower oil, rapeseed oil, refined vegetable oils and soy oil. Instead, choose avocado oil, ghee or coconut oil for high temperature cooking and olive oil for low temperature cooking. 

Finally, optimising vitamin D3 levels and exercise have also been shown to have a positive impact on HDL cholesterol levels. As we are moving into the winter months, it may be worth considering vitamin D3 supplementation to help tie you over until April/May when the days become a lot brighter. 

Estimated reading time: 5 mins

The Gut Brain Axis

The gut microbiome, defined as the bacteria that colonises our digestive tract, seems to be a buzz word at the moment within the health industry, as a growing body of research is showing just how important quantity and quality of protective gut bacteria are for our health. But the most interesting recent discoveries concerning gut bacteria are how they interact with our brain, in a system that has been labelled the gut-brain axis. This axis represents a two-way relationship between the gut and the brain, whereby our bacteria help communicate messages to our brain and neurochemicals communicate from our brain to our gut. Not only have researchers found that gut bacteria are important for gut motility and nutrient absorption, but they are also finding that these 100 trillion microorganisms, that represent around 1000 different species, can actually modulate brain development and activity, as well as playing a role in conditions such as autism.

Autism and IBS

In the UK, there are over 700,000 people who are on the autism spectrum, which is a lifelong condition that can greatly impact the lives of those living with autism and their relatives. Research has continuously shown that those on the spectrum commonly have comorbidities related to digestive function, such as IBS. In a study of 255 (184 males/71 females) children with autism between two and 3.5 years of age and 129 (75 males/54 females) typically developing children in the same age group, it was found that preschool-aged children with autism were 2.7 times more likely to experience GI symptoms than their typically developing peers. Almost 50% of children with autism reported frequent GI symptoms — compared to 18% of children with typical development. It is not yet understood why this is the case, however the research on how our gut microbiome can influence brain activity is providing the grounds for new therapeutic measures for conditions like autism. 

The role of short chain fatty acids

The composition of our gut bacteria and its diversity is often dependent on the food that we eat. Insoluble fibre such as cellulose, xylans and inulin found in foods such as vegetables and whole grains, provide fuel for our gut bacteria to flourish and ferment to create short-chain fatty acids (SCFAs). These fatty acids, produced by protective bacteria, can reduce the production of proinflammatory molecules called cytokines and can enhance anti-inflammatory processes. SCFAs produced by certain strains of bacteria have also been found to be capable of producing neurotransmitters such as GABA, which is an inhibitory neurotransmitter that helps to regulate anxiety. Bacteria can also produce a set of neurotransmitters called monoamines such as dopamine, which helps control the brain’s reward and pleasure centres, serotonin, our mood stabilizer, and noradrenaline, a neurotransmitter that’s involved in our fight or flight stress response. The vagus nerve, which travels from the intestine to the brain, enables neurochemicals produced by the gut bacteria to be signalled to the brain.

SCFAs produced by pathogenic bacteria, such as the Clostridial species, have on the other hand, been shown to be elevated in those with autism. Disrupted gut bacteria has been frequently associated to autism in studies showing unfavourable amounts of pathogenic bacteria in stool samples and in biopsies of children on the autism spectrum. A variety of drivers such as early weaning from breast milk to infant formula, which was related to increased fecal concentrations of SCFAs produced by pathogenic bacteria, and genetic alterations that can negatively impact how food is digested, have been shown to play a role in symptoms associated to autism. 

Stress and the gut

Research has also shown how psychosocial stress can negatively impact our gut, by altering the composition of gut bacteria and thereby increasing inflammation. This is further evidence for the two-way relationship that exists between the brain and the gut, whereby externally-perceived stress can have a direct influence on the health of our digestive tract. A study measuring lactic acid bacteria (protective bacteria) in college students undergoing the stress of final examinations, found a significant decrease in this type of bacteria after the examination. In addition, studies observing the behaviour of bacteria-free mice, showed a wide range of deficits in brain and gut biochemistry, social behaviour and stress responses compared to mice inoculated with gut bacteria, again giving strong evidence for the role of gut bacteria in modulating brain activity. 

In children with autism, the presence of dysfunction in the gastrointestinal tract is commonly associated with aggressive behaviour, tantrums, anxiety, irritability and sleep disturbances. Research on probiotics (supplements containing protective bacteria) and their beneficial effect on gastrointestinal conditions such as irritable bowel syndrome and diarrhea, is well-established. Considering this, it is not surprising that the use of probiotics as an integrative therapeutic approach to autism, is now being extensively investigated. Although the exact mechanism of how probiotics can modulate behaviour and mood in those with autism is not yet fully understood, researchers have posited that this may be due to how protective bacteria target circulating neurotransmitters and neuroimmune responses within the gut-brain axis. Probiotics have been found to reduce certain metabolites that have been associated to autism and gastrointestinal symptoms that are strongly correlated with the disorder. 

Moving towards a personalised approach

Achieving optimal nutrient intake is additionally more difficult for those with autism. This is due to a higher rate of food allergies and/or intolerances to certain foods such as dairy, nuts and wheat, as well as a tendency to towards picky eating and food selectivity. There is no one-size-fits-all diet that is right for everyone, each person is biochemically unique, with a variety of genetic, environmental and lifestyle factors that can influence health, which is why it is important to work with a trained professional. However, there are certain key dietary factors that have shown to be beneficial for those on the autism spectrum, which you can begin integrating into your child’s or your everyday life now. If you’d like to see these steps, click here to go through to our Nutrition Solutions page on Autism. 

The British Association of Applied Nutritional Therapists (BANT) has a register for qualified Nutritional Therapists in Britain. The Brain Bio Centre, our not for profit clinic, offers face to face in London and Skype appointments to enable consultations from across the UK and overseas.

CLICK HERE TO FIND OUT MORE ABOUT THE AUTISM MASTERCLASS

Estimated reading time: 9 mins

Chronic fatigue syndrome (CFS) is a debilitating condition that is otherwise known as myalgic encephalomyelitis (ME). Due to the diverse set of seemingly unrelated symptoms that people with this condition present with, it is commonly misdiagnosed and can often be confused with other conditions such as depression. 

Typical symptoms of CFS can be: 

Sleep problems
Muscle and joint pain
Headaches
Memory and concentration problems
Flu-like symptoms
Feeling dizzy or nauseous
Low mood

A mysterious illness 

CFS has long been stigmatised and ignored by many doctors due to its mysterious aetiology, often leaving many physicians baffled. This has commonly led to doctors concluding that it is purely a psychiatric illness, rather than a disease of some kind. Sadly, this means that many patients go through years of seeing various doctors before they get a proper diagnosis. 

According to the National Institutes of Health, CFS impacts 15 million to 30 million people worldwide, and leaves 75% of those affected unable to work and 25% homebound or bedridden. Although the aetiology of CFS is unclear, the condition commonly arises following a viral illness, in particular Epstein-Barr virus, herpes and mononucleosis. Since the coronavirus outbreak, there has been a large number of reports of people suffering with long-term symptoms that are akin to those of CFS. This has led to a new line of research opening, to examine the biochemical mechanisms that are leading to symptoms, such as debilitating fatigue, low mood and brain fog, headaches and more in those who have been infected with COVID-19.

A new angle to understanding COVID-19?

According to a report¹ published by the Centers of Disease Control and Prevention, more than a third of those who have tested positive for COVID-19 and have symptoms don’t feel like they’re fully recovered, even weeks and months later. Why might this be occurring at such alarming rates? Some researchers, such as Mady Hornig, Immunologist at Colombia University, have proposed that this may be due to inflammation levels going haywire in the body. COVID-19 patients exhibit abnormally high levels of inflammatory molecules², such as certain cytokines like interferon gamma, which are coincidentally the same inflammation driving molecules that are chronically present in CFS patients. This overactivation of the immune system, which has frequently been labelled the ‘cytokine storm’ in the acute phase of COVID-19, may be what is leading to long-term problems.  

Neurovirologists such as Avindra Nath, at the National Institute of Neurological Disorders and Stroke, believe that there should be more attention placed on the long term risks of COVID-19. Nath purported, in an article published in The Scientist, that viruses can seek long-term refuge in organs to hide from the immune system, which can essentially cause a constant trickling of virus particles to escape into the bloodstream leading to a chronic trigger of inflammation. However, the most obvious mechanism by which viruses can cause symptoms related to CFS is autoimmunity. Nath explains how during the acute phase of a viral infection, the body’s immune system can mistake its own proteins with viral proteins, due to an overactivation of inflammation. This, over time, can lead to mitochondrial dysfunction

A defect in the batteries of our cells?

The mitochondria are the battery-like organelles of our cells, which play an important role in a wide range of physiological processes, such as creating APT (the energy currency of our body), as well as neurotransmitter synthesis, production of insulin, iron metabolism, heat production and many more. Damage to the mitochondria can therefore have a global effect on the body, and many chronic diseases such as diabetes, psychiatric conditions and heart disease, are related to poor mitochondrial function. A key example is in the lack of ATP production that can occur in mitochondrial dysfunction – without enough ATP, we begin to experience symptoms of overall malaise, exhaustion, muscle pain, brain fog and low mood. A chronic inflammatory response that can be triggered by acute viral infections, can literally wear down the mitochondria, altering the metabolism and functioning of cells. This can have a far-reaching impact on our body and even lead to problems in normal bodily functions such as sleep. 

An example of this was seen in a case-controlled study³ carried out in 2011 and published in BMC Neurology, which looked at 22 healthcare workers who had been infected in 2003 with SARS-CoV-1 and were left with chronic exhaustion, musculoskeletal pain and sleep disturbances. After performing EEGs (electroencephalogram) on the study participants, they found elevated levels of alpha EEG anomaly and apnea. The alpha-EEG anomaly has been found to interrupt normal restorative aspects of sleep and many studies⁴ have identified this anomaly as a consistent feature in patients with fibromyalgia, a condition that leads to similar symptoms to CFS. 

The best offence is a good defence 

As the well-known adage goes, ‘the best offence is a good defence’ – the most important thing we can do to protect ourselves from the negative impact of viral infections like COVID-19, as well as prevent potential long term effects, is to optimise our health via nutrition and lifestyle approaches. A key trigger for mitochondrial impairment is oxidative stress⁵, caused by the following factors:

High blood sugar levels/insulin resistance
Consumption of inflammatory foods 
Chronic stress 
Alcohol
Cigarette smoking 

Oxidative stress is a term used to describe the impact that reactive oxygen species (ROS) can have on our health, which are chemically reactive unstable molecules that contain oxygen. These molecules scavenge electrons from other molecules, leaving a trail of disruption called free radical damage.  It is well known that under normal conditions, our bodies maintain a healthy balance between ROS and antioxidants, which are molecules that can donate electrons without becoming ‘unstable’ themselves and are therefore able to halt free radical damage. 

Having chronically high blood sugar levels, drinking too much alcohol, smoking, eating too many processed foods and chronic stress, are a recipe for free radical damage and therefore mitochondrial dysfunction. Here are some simple dietary changes to prevent this from happening:

Avoid sugar, in all its forms

Sugar can come in many forms, which is why it’s important to read ingredient labels. Food manufacturers often try to sneak sugar in by using other types of sweeteners such as dextrose, maltodextrin, syrups, fructose, sucrose, high-fructose corn syrup, agave, fruit concentrates and honey. Avoid products that contain any added sugars in them, as well as using sugar at home in foods and drinks.

Prioritise protein, fibre and healthy fats

To help avoid chronically high blood sugar levels, it’s important to base your diet on wholefoods rich in proteins, fibre and healthy fats. Protein can be found in meats, poultry, fish, eggs and pulses and healthy fats in oily fishes, nuts and seeds, coconut (and its oil), extra virgin olive oil and avocado (and its oil). Aiming for 50g of fibre a day is also incredibly important to help balance blood sugar levels. This means eating various types of vegetables throughout the day in your main meals. You can do this by aiming to dedicate half of your plate to a variety of vegetables at lunch and dinner.

Avoid processed foods

Processed, ready-made meals, often contain ingredients that can be detrimental to our health if eaten too often. Hydrogenated oils, sugars and additives feature frequently in packaged foods, which can trigger oxidative stress and can have a negative impact on mitochondrial health. Focus on whole foods and cooking from scratch as much as possible, so that you have control over what’s going into your meals. 

Eat a rainbow

The pigments in plants that cause them to have vibrant colours, such as the red in tomatoes, orange in carrots and sweet potatoes and greens in spinach and kale, are rich in antioxidants like polyphenols and flavonoids. These molecules scavenge free radicals from the body’s cells and help mop up any damage left by them. Try to vary your vegetable intake so that you make sure you’re benefitting from a wide variety of antioxidants. 

Nutrients and enzymes to support mitochondrial health

Aside from the above dietary changes, there are a few nutrients and enzymes that have been well researched in the context of supporting mitochondrial function.

Enzyme CoQ10

CoQ10 is an important endogenous antioxidant and enzyme that is produced by the body, which plays an important role in something called the electron transport chain, an important process that occurs in the mitochondria, which triggers the production of ATP or energy in simpler terms. CoQ10 is something that is created inside the body, however, we can get small amounts directly from external sources such as our diet. Foods such as organ meats and oily fish have been shown to contain some CoQ10. In addition, deficiencies in cofactor nutrients such as B2, B3 and vitamin E have been shown to play a role in CoQ10 deficiency, as well as the use of statin medication⁶. 

L-carnitine

Carnitine is an amino acid that’s synthesised from dietary sources of lysine and methionine, also amino acids. It is responsible for the transport of long-chain fatty acids into the mitochondria to be oxidised and used to create ATP. In previous studies, patients with CFS have displayed significantly lower levels of acetyl-L-carnitine, total carnitine, and free carnitine; and those with the lowest levels have shown the worst functional capacity ⁷. Whilst carnitine deficiency is rare, those on long term restrictive diets, as well as those with poor liver function may have issues synthesising carnitine. Lysine and methionine are widely found in many foods such as meats, poultry, eggs, fish, as well as in nuts and seeds, wholegrains such as oats, brown rice, and finally, in pulses.  

Alpha lipoic acid

Alpha lipoic is an important antioxidant that plays an essential role in supporting mitochondrial enzymes involved in glucose metabolism and energy production. In particular, Alpha lipoic acid has been shown to prevent damage caused to the mitochondria by increased levels of a substance called nitrous oxide (NO) in the body. Whilst NO is essential for blood vessel health, too much of it can be detrimental to our cells. This often occurs in acute inflammation, such as during the initial stages of an infection. Alpha lipoic acid has been shown to effectively restore mitochondrial enzyme activities inhibited by excess NO, which has a consequent positive impact on ATP production⁸. 

Supplementation with these nutrients has been explored in some studies⁹. However, it is important to work with a nutritional therapist or a nutritionist to make sure you’re taking the right dose and to investigate potential drug-nutrient interactions, for those taking medication. In the meantime, following the above dietary and lifestyle guidelines can have a profound impact on health and mitochondrial function. 

References

1.  Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb Mortal Wkly Rep 2020;69:993-998. DOI: http://dx.doi.org/10.15585/mmwr.mm6930e1external icon  

2.  Distinct plasma immune signatures in me/cfs are present early in the course of illness

3.  Moldofsky, H., Patcai, J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurol 11, 37 (2011). https://doi.org/10.1186/1471-2377-11-37 

4.  A. M. Drewes, Pain and sleep disturbances with special reference to fibromyalgia and rheumatoid arthritis, Rheumatology, Volume 38, Issue 11, November 1999, Pages 1035–1038, https://doi.org/10.1093/rheumatology/38.11.1035

5.  Guo, Chunyan et al. “Oxidative stress, mitochondrial damage and neurodegenerative diseases.” Neural regeneration research vol. 8,21 (2013): 2003-14. doi:10.3969/j.issn.1673-5374.2013.21.009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145906/ 

6.  Kristin Filler, Debra Lyon, James Bennett et al, ‘Association of mitochondrial dysfunction and fatigue: A review of the literature’, BBA Clinical, Volume 1, June 2014, Pages 12-23. https://doi.org/10.1016/j.bbacli.2014.04.001

7.  Sanford H. Levy MD, FACP, ABIHM, in Integrative Medicine (Fourth Edition), 2018. https://www.sciencedirect.com/topics/medicine-and-dentistry/carnitine 

8.  Sylvia Hiller, Robert De Kroon, Eric D.Hamlett et al, ‘Alpha-lipoic acid supplementation protects enzymes from damage by nitrosative and oxidative stress’,  Biochimica et Biophysica Acta (BBA) – General Subjects, Volume 1860, Issue 1, Part A, January 2016, Pages 36-45. https://doi.org/10.1016/j.bbagen.2015.09.001 9.  Kristin Filler, Debra Lyon, James Bennett et al, ‘Association of mitochondrial dysfunction and fatigue: A review of the literature’, BBA Clinical, Volume 1, June 2014, Pages 12-23. https://doi.org/10.1016/j.bbacli.2014.04.001

Estimated reading time: 7 mins

Periodontitis is another word for gum disease, caused by a specific bacteria called Porphyromonas gingivalis, that leads to infection of the tissue holding the teeth in place, and as a consequence, symptoms such as bleeding gums and loose teeth. 

The association between chronic gum disease and cognitive impairment has long been established, with several studies showing a strong correlation between periodontitis and Alzheimer’s disease.  In 2009, a cross sectional observational study on participants of 60 years and over, tested 2355 people for IgG antibodies to P. gingivalis. Those who had the highest levels of IgG antibodies, were more likely to have poor delayed verbal recall and impaired subtraction, compared to those with the lowest. This is significant, as we know that the presence of IgG antibodies demonstrates that the body has created an inflammatory response to the bacterium, which is strongly associated with the pathogenesis of Alzheimer’s disease. 

We already know that patients with Alzheimer’s disease exhibit neuroinflammation that is akin to a reaction to an infectious agent, like bacteria, leading to the activation of the brain’s immune cells called the microglia, as well as a cascade of cytokine production – another hallmark of inflammation. For this reason, infectious agents have been robustly studied as a key contributing factor to the development of Alzheimer’s. However, a direct causal role is yet to be established. 

“People who have suffered from gum disease for 10 years or longer are 70% more likely to develop Alzheimer’s disease…”

Despite the lack of evidence for a causative role, associations between cognitive decline and bacterial infection have continued to be established. In another more recent study, published in Alzheimer’s Research & Therapy in August 2017, where more than 25,000 people aged 50 or older participated, researchers found that people who have suffered from gum disease for 10 years or longer are 70% more likely to develop Alzheimer’s disease. This study also highlighted that in those with chronic gum disease, there was a higher prevalence of depression, traumatic brain injury and hyperlipidaemia, which may all be contributors in the development of dementia. This research suggests that there may be various factors at play, rather than just gum disease on its own.

Gingipains destroy brain cells

The bacteria responsible for the infection is not only found in those with gum disease, but has also been found at low levels in 25% of healthy individuals with no presence of oral disease. However, what more recent studies are showing is that it is the proteins called gingipains, that are released by the bacteria that are responsible for damage to nerve cells in the brain, rather than just the bacteria on its own. During experiments carried out in mice that were infected orally by P.gingivalis, scientists discovered that they later demonstrated signs of brain deterioration and infection, which are concurrent with humans showing symptoms of early-stage dementia. 

In this same study, carried out by researchers from a variety of universities, brain tissue samples from approximately 100 people with and without Alzheimer’s were analysed and tested for two different types of gingipain proteins. They also tested for the presence of gingipain DNA in both the cerebrospinal fluid and the saliva of people that had been diagnosed with Alzheimer’s. What they found was that the level of gingipains in brain tissue of those with Alzheimer’s was between 91% and 96% (for the two different proteins), in comparison to 39% and 52% in those without Alzheimer’s. Furthermore, they found gingipain DNA in 7 out of 10 cerebrospinal fluid samples in those with Alzheimer’s and 10 out of 10 for the saliva samples. 

P.gingivalis has, in addition, been shown to be extremely virulent – unlike other bacteria, studies demonstrate that broad-spectrum antibiotics rarely eradicate it and may lead to resistance to it. In addition, P.gingivalis depends on the secretion of gingipains to maintain its survival. They do this by supporting the bacteria’s colonization and the inactivation of the host’s immune defences. Whilst drugs have been developed to block the neuroinflammatory action of gingipains, trials have yet to be completed on humans to assess the efficacy of them. 

“We are working on the theory that when the brain is repeatedly exposed to bacteria and/or their debris from our gums, subsequent immune responses may lead to nerve cell death and possibly memory loss.”

Researchers from the University of Central Lancashire in the UK, report that bacteria like P.gingivalis can enter from oral cavities into the bloodstream through a variety of daily activities, such as eating, brushing teeth and chewing. However, they mention in a study published in the Journal of Alzheimer’s Disease, that the bacteria is more likely to enter the circulatory system after invasive dental treatment, which then goes on to trigger inflammation. Dr. Sim K. Singhrao, Senior Research Fellow at UCLan said: “we are working on the theory that when the brain is repeatedly exposed to bacteria and/or their debris from our gums, subsequent immune responses may lead to nerve cell death and possibly memory loss.” 

Whilst we know that having dementia can lead to difficulties maintaining daily habits like brushing teeth properly, the findings of many studies suggest that gum infections precede the diagnosis of dementia. This means that, like other modifiable risk factors such as diet, smoking, obesity and diabetes, there are things that we can do to help reduce the chance of developing Alzheimer’s disease.

How to prevent periodontal disease

Besides from the obvious dental hygiene habits like brushing teeth and the tongue after every meal to remove food and plaque, flossing and using an antibacterial mouthwash, there are also dietary measures that can be put in place to offer extra support.

For example, research shows that there is a strong association between type 2 diabetes and periodontal disease. This may be due to the fact that increased levels of glucose in the blood, due to insulin resistance, can favour the growth of certain species of bacteria such as P.gingivalis. In addition, diabetes can lead to a malfunctioning of the immune system, which leads to a decrease in antibody function and therefore more opportunity for bacterial infection. 

On that basis, it is therefore essential to avoid sugar, in all its forms, including the seemingly ‘natural’ alternatives to regular cane sugar, as well as focusing on a diet that helps to stabilise blood sugar levels.

Here are some practical dietary steps to help protect your teeth and gums from periodontal disease:

1. Avoid sugar and any products with added sugar in them. Beware of the different names for sugar –  just because a product doesn’t contain sugar in the ingredient list, does not mean it hasn’t had an added sweetener to it. Here are some examples of sugar substitutes to be aware of and avoid:

Dextrose, Fructose, Galactose, Glucose, Lactose, Maltose, Sucrose, Beet sugar, Cane juice crystals, Coconut sugar, Corn syrup solids, Crystalline fructose, Date sugar, Dextrin, Diastatic malt, Ethyl maltol, Florida crystals, Glucose syrup solids, Grape concentrate, Maltodextrin, Agave Nectar/Syrup, Barley malt, Blackstrap molasses, Brown rice syrup, Buttered sugar/buttercream, Caramel, Carob syrup, Corn syrup, Evaporated cane juice, Fruit juice, Fruit juice concentrate, Golden syrup, High-Fructose Corn Syrup (HFCS), Honey, Invert sugar, Malt syrup, Maple syrup, Molasses, Rice syrup, Refiner’s syrup, Sorghum syrup, Treacle. 

2. Avoid fruit juices and in particular shop-bought fruit juices, which often contain fruit concentrates. Whilst fruit is a natural form of sugar, fruit juices often contain the juice of the fruit without its pulp or fibre. This means that it is very quickly converted into glucose (sugar) in the body, which leads to blood sugar imbalances and eventually insulin resistance, if consumed too frequently. 

3. Eat a diet that mainly consists of foods in their natural form, paying attention to meals that prioritise protein such as in pulses, eggs, poultry, meat and fish, along with a wide variety of vegetables and healthy fats found in nuts and seeds, avocado and extra virgin olive oil. 

4. Switch refined carbohydrates for complex carbohydrates – these are foods that are naturally high in fibre such as whole grains like brown rice, wholemeal bread, quinoa and oats, as well as starchy vegetables like beetroot, sweet potatoes, carrots, pumpkin and butternut squash.

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The Gut-Brain Axis

The ‘Brain-Gut Axis’ is a term used to describe the two-way communication system between our digestive tract and the brain.  A growing body of research into this axis demonstrates how much influence the gut can have over the brain and vice versa.  When we speak about reactions to foods, we most commonly understand them as immediate and often dangerous allergic responses, such as the constriction of the throat and trouble breathing, or dizziness and fainting.  It is usually easy to pinpoint the food that causes these reactions because of the immediate immune system response, caused by a type of immune cell known as IgE antibody.  In contrast to this, food intolerances are mediated by IgG antibodies and these reactions can take up to 48 hours to have an effect.  Symptoms related to IgG reactions can often be manifested as chronic issues like joint ache, IBS and depression or anxiety, which are often overlooked and not associated with what we eat.

How Bacteria Influence Communication Between the Gut and the Brain

Communication between the gut and the brain is controlled via our immune system, our endocrine system (hormones) and our central nervous system, which are all under the influence of the bacteria in our gut.  The types and amount of these bacteria, known as our gut microbiome, can be directly impacted by factors such as diet, stress, pollution and medications and the composition of the microbiome is also understood to affect one’s susceptibility to food sensitivities and intolerances.

Leaky Gut = Leaky Brain

To understand further about how food intolerances can impact our mental health, it is important to explain the relationship between our gut microbiome, the immune system and our brain in a little more detail.  The walls of our digestive tract provide a barrier between what we eat and the rest of our body and an unhealthy gut microbiome can lead to increased levels of inflammation, leaving the walls vulnerable to structural damage. Our intestinal wall is composed of cell junctions that prevent bacteria and large food molecules from entering the bloodstream, however, if these become damaged, proteins from foods that should not be circulating in our bloodstream can enter and an immune response is mounted as a reaction. This response is mediated by IgG, an antibody, that helps to protect against bacterial and viral infections as well as food antigens and is the most abundant immune cell in the body. Whilst food antigens are usually quickly cleared by an intelligent system called the reticuloendothelial system, with structural damage and a poor gut microbiome, this immune response can keep reoccurring. It is suggested that a chronic immune response such as this can have a negative impact on the brain, damaging its own structural barrier, called the Blood Brain Barrier. 

The Brain’s High Fortress – The Blood Brain Barrier

The Blood Brain Barrier (BBB) is similar in structure to the intestinal barrier and is usually highly selective, allowing certain required metabolic products, such as short chain fatty acids and amino acids to pass into the brain from our wider circulation but protecting the brain from potentially damaging components. When the BBB is compromised, unwanted translocation may occur such as allowing a bacterial invasion, which can alter the function of immune cells that are responsible for regulating inflammation. Chronic inflammation is associated with many mental and physical health problems, so it is therefore suggested that poor gut health can have a direct correlation to poor mental wellbeing. This is as a result of a compromised intestinal barrier and the negative impact this has on our brain’s own structural barrier (BBB), resulting in inflammation.

The Link Between Inflammation and Depression

Large scale studies have shown the association between chronic low-grade inflammation and depression. For example, in a study that examined data from 14,275 people who were interviewed between 2007 and 2012, they found that people who had depression had 46% higher levels of C-reactive protein (CRP), a marker of inflammatory disease, in their blood samples. Studies like these are paving the way towards a new understanding of the pathology of mental health conditions and how diet and stress can alter bodily systems, such as digestive function and consequently impact mental wellbeing. 

Measuring IgG antibodies in food intolerance tests has been implicated as a popular strategy to tackle symptoms related to sensitivities such as IBS, joint pain, fatigue, migraines, anxiety and depression. A recent survey on 708 people commissioned by Allergy UK, demonstrated how 81% of those with elevated IgG levels, as well as psychological symptoms, reported an improvement in their condition after following a food-specific IgG elimination diet. Taking this all into account, health professionals and those with poor mental health may want to consider the potential role of food intolerances in mental well-being and in managing common mood-related disorders, such as depression and anxiety.

How to Heal a Leaky Gut

Foods that are rich in collagen and its amino acids, like glycine and proline, are great for healing connective tissue, which is what the intestines are made up of. A traditional food, rich in these amino acids, that has made its way into our kitchens again after rediscovering its therapeutic properties is bone broth. Another example of a group of traditional foods that can be used therapeutically in building digestive health, are fermented foods such as kefir, sauerkraut and kimchi. These are abundant in probiotics, which are the ‘good’ bacteria our digestive system needs to help keep a good balance and protect the intestinal barrier from pathogens, toxins and parasites. Once these foods have been introduced on an everyday basis along with eating a healthy nutrient-dense diet and the possible use of supplements to help restore balance, it may be possible to reintroduce foods that were previously triggering an IgG response carefully, one at a time, whilst monitoring symptoms.