Abstract
In recent years, the relationship between nutrition and mental health has significantly gained attention. Mental health problems related to gut health are increasingly being reported without any positive progress. The emerging research shows that the existing medication approaches to mental health are not practical enough to resolve the mental health problems related to the issue. Even though there is comprehensive evidence from the emerging literature regarding the seriousness of the mental problems stemming from gut health, Clinicians still hold onto medical approaches, which still need to make progress toward improving this issue. This practice application paper examinesthe role of nutrition, diet, and gut health on mental wellbeing. Specifically, the paper aims to educate clinicians about the impacts of gut-brain axis theory and how improving the bio-psychosocial model approach will help identify more gut issues, leading to better-informed decisions instead of just medication. Through this paper, clinicians will be able to understand the possible alternative approaches that may be employed to effectively address the issue of mental health stemming from gut dysbiosis. Achieves this by conducting an extensive research review on the underlying knowledge, what has been done, and reflection on the proposed interventions.
Key Words: Gut-Brain Axis Theory, Mental wellbeing, Biopsychosocial model, Gut dysbiosis, Microbiome, Mental health conditions, Nutrition psychiatry, Dietary changes
Background
The human gut microbiome is undeniably one of the most complex ecosystems, densely colonized by a significant number of microbial species. Emerging evidence demonstrates that imbalances in the gut microbiota may disrupt communication and possibly result in mental health conditions such as depression, neurodevelopmental conditions, and depression (Limbana et al., 2020). Nevertheless, despite the seriousness of this condition, most clinicians focus on administering medication to mitigate the effects of gut imbalances on mental wellbeing rather than embracing cognitive tools to inform clinicians’ understanding of biopsychosocial mechanisms, enhance early detection, employ interventions, engage in interdisciplinary collaboration, prevent adverse outcomes, and ensure permanent treatment of the conditions (Horn et al., 2023). Perturbations perpetuated by therapies such as antibiotic medication may disrupt the balance of the gut ecosystem, leading to notable reductions in microbial diversity and functional richness as well as effects on metabolic health. Consequently, mental health conditions may arise or be supported by imbalanced states or even harmful stable conditions (Tait & Sayuk, 2021).
Sadly, the conditions related to mental health as impacted by the gut microbiome continue to increase, which has even necessitated that countries such as the United States line their resources to mitigate health conditions such as bipolar, schizophrenia, eating disorders, and autism spectrum disorder (ASD) (Frame et al., 2020). Many individuals continue to suffer at the hands of mental health conditions resulting from the macrobiotic gut without practical alternative approaches, such as educating people on the proper healthy diet, which may positively impact their gut and mental health (Adan et al., 2019). The gut microbiota has been reported to be associated with high rates of suicide among mentally ill people (Uddin et al., 2017). The 2019 world statistics indicated that approximately 970 million people were affected by mental illnesses. Mental illnesses may affect a patient’s ability to learn, work, and lead an everyday life (Tilocca et al., 2020). It is important to note that, in extreme cases, mental conditions resulting from the gut can even result in suicide.
Furthermore, mental diseases could interfere with a patient’s family members’ capacity to lead regular lives. This is mainly led by stress and being unable to concentrate on activities. Various factors impact the gut microbiota, including diet, environment, season, and overall health. The physiology of the human microbiome is influenced by dietary changes, stress, and antibiotic usage (Martin et al. (2023). This change may cause increased intestinal permeability, often known as “leaky gut syndrome.” It allows objects from the gut lumen to enter the bloodstream, including bacteria and their metabolites. When abnormal gut permeability causes systemic and localized mucosal inflammation, it creates a vicious cycle (Tait & Sayuk, 021). The release of cytokines and neurotransmitters exacerbates the inflammation, further increasing intestinal permeability. These chemical mediators may alter brain function via the gut-brain axis (GBA), causing anxiety, melancholy, and memory loss.
The gut bacteria may regulate emotions via the gut-brain axis (GBA). Since Sudo discovered the GBA in germ-free mice, studies have demonstrated that gut bacteria enter the immune, neurological, and endocrine systems (Martin et al. (2023). Research on people has shown a relationship between mood disorders and increased gut bacterial translocation. For instance, compared to controls, there are notable increases in Bacteroidetes, Actinobacteria, and Proteobacteria in severe depressive illness and declines in Firmicutes.
Neurocognitive reactions to stressful sights are substantially associated with the kind of bacteria present. Prevotella predominance is linked to increased white matter in the attentional, emotional, and sensory processing areas, whereas Bacteroides enterotype is linked to increased gray matter in the frontal lobes, cerebellum, and hippocampus. The stomach has 90% of serotonin receptors (Tait, C., & Sayuk, 2021). As a consequence, the most common side effect of selective serotonin reuptake inhibitors, or SSRIs, the most extensively used pharmacological treatment for mood disorders, is gastrointestinal distress. The vagus nerve allows for morphological and physiological two-way communication between the gut and the brain, including recently discovered enteroendocrine cells in the gut. This shows how the underlying medication approaches have been ineffective (Martin et al., 2023). In addition to understanding the many relationships between food and psychological diseases such as anxiety and depression, the GBA has prompted the formation of a new field called nutritional psychiatry, which employs dietary changes as a therapeutic intervention for patients.
Dietary changes may affect happiness and mood by altering the gut microbiome. It has been shown that nutritional alterations account for 57% of the variable in the gut microbiota in mice, whereas genetic background accounted for 12%. According to a study published in Nature magazine, the ketogenic diet alters the microbiome’s taxonomic and functional makeup in kids with epilepsy. In a related investigation, Martin et al. (2023) discovered differences in the relative presentations of enterotypes in the gut microbiota in children with epilepsy. Given that altering gut bacterial enterotypes in animal models may replicate the effects of ketogenic diets without modifying the food, it is conceivable that the advantages of these diets for managing severe epilepsy are mediated via the gut microbiome (Martin et al., 2023).
Rationale for Focus
It is critical to acknowledge the limits of medical therapies in treating mental health disorders while investigating the relationship between gut health and mental wellbeing (Horn et al., 2023). The complex gut microbiota of humans is essential for controlling the gut-brain axis, which controls the flow of information between the stomach and the brain. Unbalances in the gut flora have been linked to mental health conditions including anxiety and depression, according to research (Góralczyk-Bińkowska et al., 2022). Despite pharmaceutical approaches being favored by many doctors for gut and mental health issues, holistic biopsychosocial methods are often overlooked. These methods may not effectively reduce the prevalence of mental illnesses linked to gut microbes and uncover the root causes of mental health problems related to gut dysbiosis.
The significant rationale behind discussing gut and health wellbeing is the potential disruptions presented by the medications administered by clinicians, which are not bearing any positive results in the reduction of higher rates of mental illness. Yet, many resources are being utilized to prevent not only the mental condition but also the costs associated with supporting the medication resources employed. Such perturbations may reduce functional richness and microbial diversity, with related metabolic effects and mental wellness (Góralczyk-Bińkowska et al., 2022). This stresses the need for a paradigm change in treatment strategies, replacing the underlying medication procedures with comprehensive alternatives that examine the complex issue of mental health related to gut issues.
There are increasingly many registered cases linked to gut microbiomes, such as bipolar disorder, schizophrenia, eating disorders, and autism spectrum disorder (ASD); this justifies the need for comprehensive training for clinicians to make informed decisions on the matter of reducing the effects of microbial guts on mental health (Góralczyk-Bińkowska et al., 2022).
This program aims to create a 9-hour training curriculum to inform physicians about the gut-brain axis theory’s potential benefits and how to enhance the bio-psychosocial model. The gut-brain axis provides a framework to discover more gut disorders, which will lead to better-informed judgments instead of pharmaceuticals, which are not improving this disease. Góralczyk-Bińkowska et al. (2022) found that gut and brain wellbeing connections are linked to increased suicidal cases among mentally ill individuals, highlighting the need for practical solutions to address this issue before it worsens (Góralczyk-Bińkowska et al.). According to the World Health Organization (2019), gut microbiota caused mental health disorders in over 970 million individuals worldwide, affecting learning, work, and quality of life.
The emerging evidence supports supports a comprehensive training program that emphasizes the complex relationship between nutrition, food, and gut health and mental health. Góralczyk-Bińkowska et al. (2022) found that stress, mode of administration, probiotics, circadian rhythms, and environmental exposures significantly impact the microbiome-gut-brain axis. Nutrition and probiotics may reduce anxiety, demonstrating the benefits of biopsychosocial mental health care (Schnorr & Bachner, 2016). Gut health’s influence on dietary components should also be explored to improve mental health therapy. Prebiotic fibers help beneficial bacteria grow, but contrabiotic soluble fibres prevent gut epithelial bacterial adherence (Rhodes, 2021). These results imply that practitioners should use dietary therapy to treat gut-related mental health issues holistically rather than just drugs.
Literature Review
Upon evaluation of the existing literature surrounding the complex issue of the relationship between gut health and mental wellbeing, compelling themes have emerged, revealing how the gut microbiota affects mental health. The human microbiome is a complex network of bacteria, viruses, fungus, and protozoa. These microorganisms live in the skin, mouth, vagina, and digestive tract (Feng et al., 2023). The human digestive tract, which is the heart of this microbial diversity, has 40 trillion bacteria. These microorganisms have 150 times more genes than humans (Feng et al., 2023).
Recent studies show that the microbiome’s complicated connections with its metabolites affect the tumor microenvironment (Feng et al., 2023). Unbalanced or disordered microbiomes may affect cellular signaling pathways, produce localized inflammation, and damage the epithelial barrier, which can accelerate cancer (Feng et al., 2023). Medication-focused methods may disrupt gut dysbiosis-related mental health issues, according to the literature (Feng et al., 2023).
The rising worldwide prevalence of mental disorders justifies addressing gut dysbiosis-related mental health issues. As healthcare providers increasingly use medicine, a more comprehensive biopsychosocial paradigm is needed to fully understand gut-mental health interactions (Feng et al., 2023). This literature synthesizes the underlying body of literature to provide a significant framework for the development of a 9-hour training curriculum for clinicians, equipping them with substantial insights and necessary tools to navigate the gut-brain axis and promote informed decision-making in the context of mental health treatment.
What is known about the problem or issue?
The gut, usually referred to as the second brain, harbors trillions of bacteria alongside other microorganisms that serve a critical role in the overall maintenance of mental health. According to Scharf, there is no specific definition of gut health; however, the central concept behind this phenomenon is the function of the gastrolienal tract and its role in the absorption of digestion, excretion, immunity, and mental health. Even though the GI tract is home to up to 80% of immune cells, studies reveal that trillions of bacteria line its walls, contributing to the formation of a barrier that aids in immunological tolerance, transmits signals to the brain, aids in nutrition absorption, and fights against infections (Bengesser et al., 2019). The brain receives messages from the GI tract that have an impact on mood, thought processes, and behavior. According to Scharf, there is a close communication channel between the brain and the stomach. The existing literature suggests that imbalances in the gut microbiota may interfere with this communication, which might result in mental health issues, including anxiety, sadness, and even neurodevelopmental abnormalities.
Studies reveal that, of the millions of reported mental illness cases associated with gut dysbiosis, half of them were found to be ineffectively treated. Bengesser et al. (2019) examined gut microbiota balancing methods to determine how the gut-brain axis affects bipolar illness. Bipolar people have different gut microbiota than healthy controls, with Lactobacillus, Faecalibacterium, and Ruminococcus alterations being most constant. Bipolar illness patients who take probiotics had fewer rehospitalizations and better cognitive and depressive symptoms (Bengesser et al., 2019).
Since it was feasible to research the gut microbiota, Horn et al. (2022) claimed our knowledge of its function in health and illness has greatly increased. Food affects the microbiota and metabolic processes. Some disagree on what makes healthy gut flora. The gut microbiome may affect mental health and digestion. Stress, food, and environment affect the microbiome-gut-brain axis (Gao et al., 2020). The stomach, brain, and microbiome communicate via this mechanism. Diet affects gut microbiota and brain function. According to research, some foods’ anti-inflammatory characteristics affect the microbiota and brain health. The microbiota is essential to brain and body health.
One component in the gut-brain axis shown to moderate cognitive development and health is the gut microbiome (GMB). Gao et al. (2020) indicate that some microbiome elements contribute to cognitive development, stability, and impairment and that GMB components and dysbiosis have been linked to various mental states. Because it covers the whole human experience and because the components of the microbiome are adjustable, the study of these interactions is pertinent to nursing research. It can be easily translated into the clinical context.
Heym et al. (2019) claim that the intestinal microbiota and the central nervous system communicate in both ways, to and from, within the gut-brain axis. Through various pathways, including inflammation, Bifidobacterium and Lactobacillus species have been linked to psychological health issues, including depression (Heym et al., 2019). Results imply that the brain systems underlying self-judgement and cognitive empathy, respectively, may be differently linked to mood disorders by lactobacilli and inflammation, respectively.
There is a lot of knowledge on the processes behind the health advantages of specific diets, and most of the supporting data needs to be more detailed or even contradictory. According to Rhodes (2021), understanding the intricate relationships between food, the microbiota, and the gut epithelium is necessary to explain the notable regional variations in colorectal cancer incidence, which is likely related to nutrition. Although dietary fibers have the potential to function as prebiotics by promoting the development of saccharolytic bacteria, other processes are equally crucial.
Rhodes (2021) further suggests that soluble fibres may, but do not always, have a “contrabiotic” action that prevents bacteria from adhering to the epithelium. This is especially true of pectins (galacturonic), while fructans in food previously thought to be advantageous prebiotics may cause inflammation via the harmful effects of elevated butyrate concentrations (Rhodes, 2021). This implies that the existence of a compromised mucus layer combined with possibly hazardous fecal butyrate concentrations may contribute to ulcerative colitis. Specific dietary glycans may hinder the crucial process of lectins’ epithelial adhesion. These lectins may be bacterial or dietary, such as the galactose-binding lectin produced by the colon cancer-associated Fusobacterium nucleatum.
On the other hand, emulsifiers included in processed meals may change the microbiota and enhance bacterial translocation, leading to cancer or inflammation (Rhodes, 2021). Concentrating on more than one illness has minimal benefits despite more emphasis being paid to the development of public health messaging and the mounting knowledge about the effects of dietary components on all-cause mortality. The intricate relationships that exist between nutrition, the microbiota, and health are still just beginning to be understood.
Functional gastrointestinal disorders (FGIDs), which cause stomach pain without a structural or biochemical cause, are widespread in internal medicine. Tait & Sayuk (2021) discovered that up to 22% of people worldwide are believed to be affected by functional dyspepsia and irritable bowel syndrome (IBS), which are often accompanied by other somatic and pain problems that lack a clear anatomical cause. To optimize patient management techniques and create therapeutic objectives, it is essential to have a thorough awareness of the current understanding of the molecular basis for these illnesses (Tait & Sayuk, 2021). The latest Rome IV recommendations identify functional abdominal pain disorders (FGIDs) as gut-brain interaction disorders, highlighting the brain-gut axis’s participation in these illnesses.
Tait & Sayuk (2021) define the fundamental brain-gut axis (BGA) as a complex network of reciprocal communication existing between the enteric and central neuronal systems. Through two-way communication between the main and enteric neural systems, the gut-brain axis (GBA) links the brain’s emotional and cognitive centers to the peripheral intestine (Tait & Sayuk, 2021). Recently, science has provided profound insights into how gut microorganisms affect these relationships. Through neurological, endocrine, humoral, and immunological pathways, communication occurs between the gut microbiota and the brain as well as between the brain and the gut microbiota in this bidirectional connection between microbiota and GBA. Microbiota-GBA interactions in clinical practice are supported by the connection between dysbiosis and central neurological diseases, for instance, autism and anxiety-depressive behaviors, and functional gastrointestinal conditions (Tait & Sayuk, 2021). Irritable bowel syndrome is one instance of how these complex connections are disrupted, and a better comprehension of these modifications may result in the creation of innovative targeted therapies.
What has been done to address the problem or issue?
The biomedical paradigm that ruled in the mid-1900s was problematic, and the BPS was established to address these concerns (Bashmi et al., 2023). Engel observed flaws in the biomedical paradigm, which saw the patient as an object, was reductionist and dualistic (thinking of the mind and body as separate entities), and only considered biological issues when treating a patient’s disease (Bashmi et al., 2023). Working with Romano, Engel aimed to give a more thorough approach to diagnosing and treating a patient’s pain and illness by emphasizing the social and psychological factors that influence the patient’s subjective experience. Another significant effort lies in the attempts to treat stomach cancer, which is thought to be closely related to the Helicobacter pylori bacteria. The possible interaction between Helicobacter pylori infections and changes in the makeup of the intestinal microbiota may aid the development of gastric cancer.
In light of this, the BPS model described illness as the result of the interaction of biological, psychological, and social elements; thus, treatments in the domains of biology (medicine and surgery), psychology (psychotherapy), and society (health policy reforms) would all be included in the definition of treatment (Ma et al., 2019). Engel said that the humanistic and patient-centred approach of seeing a patient and their characteristics as human beings was essentially lacking from the biological paradigm, which was represented by the BPS model (Bashmi et al., 2023). Engel anticipated that the BPS model would improve as a “scientific model” for medical education, research, and practice. Despite its shortcomings, the BPS model is nevertheless widely regarded as a valuable teaching tool in psychiatry (Bashmi et al., 2023). It is proposed that, rather than assuming homogeneity across communities, cultures, and societies, the model may benefit by broadening its scope and conceptualizing cultural and structural features, focusing more on cross-cultural differences and circumstances from social, political, and economic perspectives (Bashmi et al., 2023).
Obi-Azuike et al. (2023) examined whether the gut-brain axis may cure gut-related mental health concerns in bipolar patients. Their results suggested that the gut-brain axis may reduce mental health issues (Obi-Azuike et al., 2023). Bipolar disorder patients with probiotic supplementation had fewer rehospitalizations, depressive symptoms, and cognitive impairments. This shows that probiotic supplements and other gut-balancing therapy may help cure bipolar disorders.
A recent study shows gut microorganisms and hosts are mutualistic. The gut microbiota affects host development, physiology, and behavior. Fan et al. (2021) argue that intensive pig breeding may cause psychological disorders, weight loss, and low-quality meat, hurting the swine business. Tryptophan and dietary fiber metabolites may help with these issues, but since mice and pigs vary in physiologies and metabolisms, care should be taken (Fan et al., 2021). Gaining insight into the gut-brain connection in pigs might lead to the development of new approaches to enhancing swine health. Research has shown that tryptophan supplementation in the diet improves milk output and reproductive efficiency while lowering stress and fighting behaviors (Fan et al., 2021).
What areas still need to be examined?
While a broad body of literature suggests the potentiality of the gut-brain and its implication in addressing the pervasive issue of mental conditions related to gut health, several gaps need to be addressed (Grajek et al., 2022). One notable gap is presented by the limited insights on how effectively this intervention can work with medication approaches that have existed for a long time. Some studies, such as the research conducted by Azuike et al. (2023), point out that probiotics can be an effective supplement to the mitigation of mental issues related to the gut health of people with bipolar conditions. However, this research needs to offer profound insights into how this intervention may supplement medication processes.
While it is true that the gut-brain axis theory presents a prominent alternative to the treatment of mental health conditions, it is essential to acknowledge that, despite being compelling enough, medication approaches have also managed to mitigate the issue by a considerable percentage, which means supplementing them with these alternatives may develop a holistic approach to effectively address the issue of mental health related to gut health (Heym et al., 2019). There is a need for further research to demonstrate how the developed alternatives can work alongside the existing medication procedures.
Another notable gap lies in a critical understanding of the long-term effects of medication-centric approaches on gut health and the various ways in which these may result in dysbiosis. The underlying research only focuses on pointing out the disruptive nature of medication approaches; however, it does not show how the emerging alternative methods would be sustained in the long run, nor does it highlight the possibility of these interventions resting a healthy gut microbiota (Puri et al., 2023). It could be better if the research in this realm points out the development of strategies to address the negative repercussions of medication on gut health and contribute to the overall improvement of human health.
The research emphasizes the need for an integrated biopsychosocial approach to mental health concerns, but it does not illustrate its practical adoption in real-life healthcare settings (Heym et al., 2019). The suggested clinician training program is a good start, but further research is needed to assess its impact on educational initiatives and clinical judgments. Further study is necessary to understand the gut-brain axis’ practical side and challenges to adoption (Heym et al., 2019). This bridges the gap by letting people consider different techniques’ useful results and trust them.
Clinical-Based Intervention
My clinical-based intervention is based on a comprehensive training curriculum meant to teach all clinicians the alternative way of addressing the complex issue of health and mental wellness. This program uses the literature to educate doctors on the gut-brain axis’ potential to treat gut dysbiosis-related mental illnesses (Fassarella et al., 2020). Such as anxiety, depression, and neurodevelopmental disorders; while the emerging literature has clearly shown the seriousness of the mental condition and the shortcomings of current medication approaches, the gut-brain axis aims to provide an alternative framework that addresses the issue by identifying the root causes and the various gut issues that result in mental health problems, equipping cli
The 9-hour workshop-based training curriculum will teach clinicians gut-brain axis theory and help them adopt more advanced biopsychosocial models in mental health. The research found that pharmacological approaches interrupt mental health treatment, requiring more informed and holistic approaches (Puri et al., 2023). This shift is essential to tackling the widespread mental-intestinal health problem.
This gut microbiota and its metabolites help maintain host health. Chronic metabolic disorders, including obesity, diabetes, and cancer, are linked to gut microbial dysbiosis. It is also related to mental health, which has garnered attention recently (Bashmi et al., 2023). Brain and mental health may be affected by the vagus nerve, how microbes control neuro-immune signaling, how microbes break down serotonin, how microbes control hormonal function, and how microbes make neuroactive chemicals.
Gut microbiota is complicated; certain microbes may safeguard mental health, while others may cause mental problems. One of the most frequent mental diseases, anxiety, is linked to the gut microbiome. For instance, individuals with generalized anxiety disorder (GAD) have more Fusobacteria and Bacteroidetes but less Firmicutes spp. and SCFA-producing microbiota due to social isolation. Targeting gut microbiomes may reduce anxiety (Puri et al., 2023).
Nutrition, diet, gut health, and mental health literature will inform the curriculum training program. Góralczyk-Bińkowska et al. (2022) identified key elements affecting the microbiome-gut brain axis, including administration channels, circadian rhythms, environmental exposures, and probiotics. The training curriculum emphasizes integrative techniques like diet and probiotics, demonstrating biopsychosocial benefits in mental healthcare.
According to Gao et al. (2020), gut microbiota is linked to eating disorders, bipolar illness, schizophrenia, and autism at high rates. This means doctors require comprehensive therapy to make meaningful judgments on microbial influences on mental health (Fassarella et al., 2020). The main goal is to educate professionals about the gut-brain axis’ alternative therapeutic approach and help them replace ineffective medication.
Gut microbiome dysbiosis is linked to depression, a serious public health issue. Studies have shown variations in fecal microbiota composition bacterial families between healthy people and MDD patients. This training program will examine the long-term impacts of medication-centric methods on gut health and explore techniques to mitigate them. Additional theoretical and practical insights into integrated biopsychosocial techniques will be offered. Clinicians must evaluate the curriculum’s ability to bridge theoretical knowledge and actual application to trust and accept different ways. By promoting the biopsychosocial model and gut-brain axis theory, the 9-hour clinician training program helps treat gut-related mental health issues. This can improve patient outcomes, lessen mental disease, and improve overall mental health.
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