November 18, 2011

Fire in the Whole

There is a phrase in functional medicine that says: fire in the gut, fire in the brain.

What this means is that inflammation (Latin for ignite or set alight) in the GI system will lead to inflammation in the brain (and body systemically).   GI irritation can come from multiple factors- food sensitivities, bacteria, yeast, medications, stress, etc. The intestinal wall is just one cell layer thick and bound together by “tight junctions.”  Just beneath this cell layer lies the GALT, or Gut-Associated Lymphoid Tissue), which constitutes approximately 60% of our immune system.  When the gut becomes inflamed or irritated, these tight junctions become permeable, allowing food-stuff, bacteria, yeast, etc -essentially anything in your intestine that is small enough to fit through that space- into your body, setting off the immune response cascade.  This process is commonly referred to as the  leaky-gut syndrome.  The subsequent inflammation then compromises the blood-brain barrier, making it permeable like the gut and susceptible to the same pathogens. Some of the food-stuff peptides, in particular gluteomorphins (from gluten) and caseomorphins (from casein), actually bind to the opiate receptors in the brain, leading to a whole host of possible psychiatric symptoms and “brain-fog.”  Leaky brains can actually look like anything neurological or psychological, with markers of inflammation being elevated in dementia, depression, anxiety, inattention, etc.  Interestingly, it’s been thought that omega-3 fatty acids exert their anxiolytic and antidepressant effect through their anti-inflammatory role in diminishing cytokines, which are proteins signals involved in inflammation; omega-3′s also help repair the blood-brain barrier.  Although GI irritation can be obvious in some instances, like the gut-brain connection in irritable bowel syndrome or the psychiatric problems of celiac disease, most of the time the affected host has no idea that there is a GI issue as all they experience is depression or anxiety or fogginess.  A C-reactive protein level might indicate nonspecifically that there is some type of inflammation in the body.

So a major consideration in assessing and treating any psychiatric ailment  is addressing the possible role of gastrointestinal inflammation.