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Inflammation and How it Contributes to Psychiatric Conditions

As a mental health professional, I have seen patients who, time and again, exhibit signs of inflammation that negatively affect their health. Modernity comes with a lot of benefits but unfortunately our modern lifestyles, our diets and other environmental factors create a situation where inflammation is incredibly common. And, that’s a problem because this inflammation can amplify and even cause a deterioration of physical and mental well-being.

There is an unbreakable connection between the immune system and the brain. Cytokines, inflammatory proteins secreted by the immune system, have a profound impact on the brain. Inflammation is positively associated with mental health disorders such as anxiety, depression, bipolar disorder, schizophrenia, dementia and autism[1].

Depression, anxiety and bipolar disorder are associated with cytokines that cause inflammation in the body while suppressing other immune responses causing symptoms such as body aches, headaches and increased susceptibility to infection[1]. These cytokines change thinking and behavior by decreasing the amount of some neurotransmitters in the brain such as serotonin, dopamine and norepinephrine. The cytokines also increase glutamate which is a neurotransmitter associated with anxiety, seizures and mania. Another negative result is the decrease of a substance called brain-derived neurotrophic factor, which allows the brain to form new brain cells and increases the number of connections between brain cells causing a decrease in the ability to problem solve and retain information[2].

Chronic inflammation can wreak havoc on the body causing disruption of the GI tract, hormones and the brain. Inflammation can be caused by stress, disruption of the environment and integrity of the GI tract, infections, toxins, certain medication, obesity, malnutrition, lack of exercise, dysregulated sleep and lack of positive social interaction.

Stress causes an inflammatory response to help our bodies adapt to what it sees as potentially life-threatening situations. The body “turns off” much of the parasympathetic nervous system which is responsible for helping us to relax, digest food and repair cellular damage in favor of “turning on” the sympathetic nervous system which directs bodily resources to releasing stored energy such as fat into the blood stream for quick energy, more inflammatory cytokines and clotting factors to keep us from bleeding to death if our bodies are harmed[3].

Disruption of the GI tract can create inflammation through a variety of mechanisms. Greater than half of the immune system is located in the GI tract. The GI tract is made up of cells that fit tightly together, like a filter, so that very small nutrients can enter the blood stream but no toxins such as large proteins that come from bacteria or viruses can enter. Beneficial microorganisms in the GI tract reduce inflammation by crowding out invasive microorganisms and producing anti-inflammatory short-chain fatty acids. When the balance of beneficial microorganisms in the gut is disrupted an increase in inflammation can occur. This can be caused by certain medications such as antibiotics which can indiscriminately kill bacteria, including beneficial bacteria[4].

Certain foods and medications can cause a cascade leading to inflammation. They loosen the tight junctions between the cells of the intestines and allow large proteins to enter the blood stream. The body sees these large proteins as foreign and will mount an inflammatory response to fight them. The most major food culprits are alcohol and proteins that come from wheat such as gluten and gliadin. The protein gliadin causes loosening of the tight junctions in the intestines, even in non-celiac and non-wheat sensitive individuals[5].  Food sensitivities (foods that are poorly digested by the body and result in physical symptoms) can also cause inflammation in the body. Dairy is the most common food sensitivity affecting 65% of the population[6]. Over-the-counter anti-inflammatories such as ibuprofen, naproxen and acetaminophen can cause damage to the lining of the intestines, causing toxins to enter the bloodstream[7].

Obesity is a pro-inflammatory condition[8]. Fatty adipose tissue releases pro-inflammatory cytokines. Weight loss can improve mood and sleep. Having healthy beneficial gut microorganisms can help decrease obesity[4].

A deficiency of nutrients or lack of nutritional balance can cause inflammation in the body. Having an appropriate fatty acid ratio of omega 6 to omega 3 fatty acids is very important in controlling inflammation. Omega 6 fatty acids come from vegetable oil, canola oil, soybean oil and peanut oil. Omega 3 fatty acids come from the fat of animals that eat mostly green plants such as grass, leaves, seaweed and algae. Omega 3 fatty acids are also high in certain nuts and seeds such as flax seeds, chia seeds and walnuts. Humans evolved to have a 1:1 ratio[9]. Most Americans have a fatty acid ratio of approximately 16:1. A deficiency of Vitamin D is associated with an increase in inflammatory cytokines. Vitamin D is the “sunshine vitamin”. Our bodies produce it after being exposed to sunlight. Forty-two percent of the US population is vitamin D deficient[10]. Particularly those patients with inflammatory autoimmune conditions such as multiple sclerosis have anti-inflammatory benefits from supplementation of vitamin D[11]. Deficiencies of certain minerals are associated with immune disfunction and inflammation; prevalent minerals include zinc, selenium and copper[12]. Deficiencies in B vitamins such as B12, Folate and B6 are also closely tied to inflammation and brain disfunction[13]. One class of medications that majorly contributes to vitamin and mineral deficiencies are proton-pump inhibitors or PPIs. PPIs, commonly used over-the-counter to treat indigestion and heartburn, include medications such as Prilosec, Prevacid and Nexium. PPIs work by reducing acidity in the stomach, which inadvertently decreases the absorptions of nutrients from the digestive tract[14]. Glyphosate, a weed-killer, which is sprayed on non-organic crops such as corn and soy is another culprit. Glyphosate impairs the body’s ability to use vitamin D, depletes minerals and impairs the body’s ability to use protein to manufacture neurotransmitters[4].

Lack of exercise causes an increase in inflammatory cytokines. There are several mechanisms by which this occurs. Decreased physical activity is associated with a decrease in muscle mass and an increase in fatty adipose tissue which produces the inflammatory cytokines. Lack of physical activity also causes a decrease in circulation which makes the body less able to send toxins and wastes products to the digestive and urinary tracts for excretion[15].

A dysregulated sleep schedule negatively affects metabolism and increases inflammation. Sleep deprivation or excess are common complaints in those with depression. Sleep disturbance is associated with increased markers of inflammation in blood tests. Sleeping less than 6 hours or more than 8 hours per night is associated with elevated levels of systemic inflammation[16]

Lack of positive social interaction is positively associated with increased inflammation and cardiovascular disease. Social isolation is a form of stressor. This mounts a stress response in the body and can also increase the possibility that an individual will self-medicate with pro-inflammatory foods, alcohol or medications[17].

A typical example of our lifestyle leading to inflammation is A.B., a 25 year-old-female. A.B. came into the clinic complaining of constantly feeling tired and anxious. She complained of her body feeling “heavy” and not feeling motivated to complete activities. She complained of headaches daily that she would frequently treat with ibuprofen and she would have panic attacks several days per week. A.B. grew up in a household where she was constantly berated by her mother and as a result, she would frequently view neutral interactions with family and co-workers as negative. She had no close friends, she was a single mother and she worked a full-time job. Her daughter would go to daycare and A.B. would “catch every cold and stomach bug” that her daughter might bring home from the daycare. A.B. admitted that her diet was “not the best” and she was too fatigued to exercise. She was always in a time crunch to get things done and would often get fast food and seldom cooked at home. She was overweight reported that she did not feel good eating this way and would often have to take Prilosec to help with the heartburn.

A.B. was placed on a gluten-free, dairy-free, anti-inflammatory diet. She was advised to gradually increase exercise 20 minutes daily and to reduce and eventually eliminate the use of Prilosec and ibuprofen. Laboratory results were obtained and she was advised to supplement her diet with Vitamin D, Omega 3 fatty acid and a high-quality multi-vitamin. A.B. began attending a weekly support group for women with depression as well as weekly individual therapy to work on stress management techniques and to address her childhood trauma. Her improved diet allowed her to gradually discontinue her use of the Prilosec. And, after 2 months of these anti-inflammatory interventions her headache frequency was greatly reduced, allowing her to reduce her Ibuprofen use. At 3 months A.B. reported a resolution of her depressive symptoms, her anxiety had become “mild”, she felt less stressed, she had lost 20 pounds and felt like the time spent with her daughter was of a higher quality.

Like A.B. our modern lifestyles have resulted in factors that inadvertently create inflammation and mental health problems. We get run down with all the responsibilities. We let the convenience take hold of us, and we assume the things that are new are always good. We’ve become blind to the negative factors that lurk in our everyday decisions, and the way these factors can compound upon each other, slowly damaging our health and well-being. But, there are simple interventions that can get us on the right track to healing ourselves and living a happier and healthier life.

References

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