Is the gut microbiome the key to improved mental and physical health?

This year, National Diabetes Week is once again focusing on the impact that living with diabetes can have on mental health, particularly in relation to the stigma many people with diabetes experience.

With Diabetes Australia reporting that 80% of people have experienced diabetes stigma, and nearly 50% experience mental health challenges generally, it is clearly an issue that needs further focus and awareness.

Traditionally, there has been a tendency to treat mental and physical challenges as separate issues; however, it is becoming clearer that this is not the best approach. There is a cyclic nature to managing mental health and physical health issues, so it makes more sense to treat them as a whole.

The gut–brain axis (GBA) plays a significant role in our mental health, and measurable improvements to an individual’s mental state can be achieved by gut microbiota modification through dietary changes.

Mental health and diabetes management are inexorably linked

Managing diabetes is an inherently stressful exercise, even after the initial shock of diagnosis has worn off. The idea that a person will have to strictly manage their daily activities and possibly take medication for the rest of their life is a significant burden. There is still a widely held stigma that diabetes — particularly type 2 — is somehow the fault of the individual living with it. It isn’t surprising, then, that many people with diabetes feel paralysed and hopeless. Unfortunately, low mood and declining mental health can result in inconsistent management of diabetes, which results in a further decline in mental health, worsening diabetes symptoms and so on in a negative feedback loop.

In fact, it has been shown in multiple studies that the more people are pressured to improve, the less likely they are to achieve optimal blood sugar values. This can lead to poor blood glucose management which then places a physical burden on feelings of wellbeing, making it harder for the individual to motivate themselves. Symptoms get worse, mental health declines and so the cycle continues.

Reversing the cycle

It is essential that we help people living with diabetes to enter a positive cycle:

• Results — Anything that produces a tangible result (no matter how subjective) will dramatically reduce worry of the individual.
• Empowerment — Anything that puts control back into the hands of the person living with diabetes will lead to better physical and mental health outcomes.
• Make is easier — Anything that makes blood sugar management easier will help management, improve outcomes and lead to less stress.

Manipulation of the GBA to improve mental state

The GBA describes the two-way communication between the central and enteric nervous systems (the system of nerves around and controlled by the gut). Digesting food is one of the most complex and important parts of our biology, as it is where we get almost everything that our body uses to survive and grow (apart from air and sunlight). It is also one of the most high-risk areas of biology, as it is where the body interacts with the environment the most (the average person consumes up to 1.3 trillion bacteria a day from food). It makes sense, then, that a large part of a body’s nervous and immune system is dedicated to intestinal health.

There are three basic ways that the gut environment can influence mental state:

1. Systemic inflammation. An enhanced inflammatory response in the gut, caused by immune activation by microbial populations, leads to systemic inflammation (a general increase in the inflammation of the whole body). This, in turn, leads to stimulation of the peripheral immune system, which causes feelings of pain and unease.
2. Communication through the vagus nerve. There is direct feedback through the vagus nerve, which the brain interprets as mental state. Poor digestive function has been shown to equate to unease, anxiety and even depression. When people experience ‘butterflies in the stomach’ this is the communication travelling down the vagus nerve, with those feelings of anxiety translating to digestive distress.
3. Bacteria produce and consume neurotransmitters and other essential molecules. About 80% of neurotransmitters are used for the gut to function. The biochemistry of the body is geared towards prioritising digestion, so if there is a deficiency in neurotransmitters they will go to the gut and alter the mental state. It is also estimated that up to 90% of the body’s serotonin is produced by the microbes in the gut. So changing the microbiome can increase the availability for the rest of the body. This is also an active process, as it has been shown that the microorganisms in our gut produce serotonin, dopamine and other neurotransmitters so that they may modify our eating habits.

Effective diet management and microbiome control positively impacts both mental health and diabetes

There are several studies showing that microbiome modification has an impact on mental state. For example, animal studies have shown that manipulation of the microbiome has an impact on the behaviour of rodents. Quantifiable changes in quality of life have been observed in human clinical trials as well. In one study of diabetes management, the addition of functional food product NutriKane D, designed to modify the microbiome, resulted in significant improvement of quality of life (QoL) scores over diet and exercise alone.

Functional foods that specifically modify the microbiome, such as NutriKane D, can help with diabetes management in many ways.

In another study of people recovering during long-term hospital stay, not only was QoL improved, so was cognitive function when microbiome-modifying food was added to the regimen. Even people living with spina bifida see improvements with microbiome modification.

Apart from the purely physiological changes observed, however, is the potential to positively impact mental health. Just as there is a negative feedback loop between poor diabetes management and poor mental health, there is a positive feedback loop between good diabetes management and good mental health. The statistics quoted at the start of this article do not paint the full picture — it has been shown in one study that mental health rates approach those of the non-diabetic population in people that are managing their diabetes effectively and have more regular consultation with their healthcare professionals. Any activity that promotes feelings of empowerment and reduces medication-related anxiety is a good thing.

Empowering people with diabetes to improve their mental and physical health

People living with diabetes often experience feelings of judgement, blame and guilt around their condition, and can also feel that diabetes controls their lives, rather than the other way around.

Functional foods that specifically modify the microbiome, such as NutriKane D, can help with diabetes management in many ways, helping people to not just live with their condition, but thrive. There is significant clinical data that physiological changes can be made with these functional food products, resulting in measurable improvements in a person’s QoL. Empowering people living with diabetes to take control of the management of their condition can set off that positive feedback loop, with better blood glucose management resulting in improved mental state, which leads to greater compliance to dietary management and exercise protocols, which in turn makes the person feel physically and mentally better, making the overall management of their condition easier.

Dr Malcolm Ball is co-founder and Chief Scientific Officer of MediKane, an Australian natural health company that produces plant-based functional food products developed to prevent, manage and reverse chronic health conditions including diabetes. MediKane’s flagship product is NutriKane D, which has been clinically proven in multiple studies to lower and control blood glucose levels.

A webinar invitation

Dr Malcolm Ball is hosting a webinar on the benefits of taking a ‘gut health’ approach to managing mental health and diabetes. The webinar — taking place on Tuesday, 13 July at 1 pm AEST at https://medikane.com.au/pages/webinar — is open to healthcare professionals, people living with diabetes, and anyone with an interest in managing diabetes and mental health naturally.

Top image credit: ©stock.adobe.com/au/T. L. Furrer