We often talk about the mind and the body as two separate entities, although scientifically speaking, they are one and the same. The medical establishment has known this since the adoption of the Hippocratic Oath, and yet several millennia later, treatment of psychiatric patients is still often done in entirely separate institutions and most insurance plans don’t consider mental health related treatments as standard care, let alone necessary for effective medicine. Despite the increasing awareness of the fear and stigma surrounding mental illness, we continue to think about, discuss, and treat mental and physical illnesses separately, because that’s the way it has always been and old habits die hard.
The problem with this historical separation is most evident when mental and physical illness occur simultaneously, as they very often do. Many people living with chronic physical illnesses report that the psychiatric symptoms of anxiety and depression that almost inevitably accompany their diagnosis are far more debilitating than their physical suffering, and they wish that doctors would treat the two with equal importance. Similarly, many psychiatric patients suffer from terrible physical health issues as a result of their conditions as well as the often detrimental side-effects of antipsychotic and antidepressant medications (the mechanisms of which, by the way, are still not fully understood). While in many severe psychiatric cases, such medications remain a necessary component of effective treatment, prescribing them to treat milder cases of anxiety and depression could very well cause more harm than good.
Whether it’s psychosis or cancer, the primary illness is the one that is treated, and the rest are considered side-effects that must be tolerated because they’re less likely to kill you. While prioritizing like this is an effective way of keeping people alive, it is a very ineffective way of keeping them healthy and happy. What would happen if we started to consider the possibility that side-effects and comorbidities could be central components of complex illnesses or imbalances, and our body’s way of signalling that it’s not that simple? A new field of research suggests that causal links between mental and physical symptoms may exist at a much more fundamental level than previously thought, via two of the body’s most distant and unlikely partners – the gut and the brain.
Contrary to the way we think of ourselves as singular beings, the human body is actually a superorganism housing billions of microorganisms like fungi, bacteria, viruses, and protozoa living inside our organs and on our skin and hair. Collectively, these comprise 90% of the total cells and genes of our bodies, and the microbiota found in the gut alone consists of more than one kilogram of microorganisms, known as the gut microbiome. Recent studies have shown that something as seemingly separate as the gut microbiome can have far-reaching influence on both physical and mental well-being, and that the relationship between the two is far from straightforward.
Thanks to developments in bioinformatics, studies investigating gut-brain interactions have grown exponentially, and scientists and psychologists are starting to revise their understanding of the relationship between the mind and the body. The microorganisms inhabiting our guts play a crucial role in the so-called gut-brain axis by reducing inflammation in the body and producing neurotransmitters that can affect a variety of habits and behaviors like appetite, sleep, mood, and our response to stress. As our lifestyles, environments, medical practices, and diets have transformed over the last few centuries, the microbiome has also changed drastically. In parallel, mental and neurological diseases are rapidly on the rise, and many scientists believe that this cannot be a coincidence.
The first few weeks after birth are a critical stage for the development of healthy gut microbiota, and problems in this stage can lead to permanent neurological damage and greatly increase susceptibility to mental health issues. Altered gut flora has been linked to a huge variety of neurological and psychiatric illnesses such as Parkinson’s disease, autism, anxiety and mood disorders, and even schizophrenia. However, since nearly all of the scientific research in gut-brain biology has been carried out in animal models, much work is needed to determine whether and to what extent the findings translate to humans, as well as to investigate whether changes in the microbiome are a cause or effect of disease. Even so, it has become abundantly clear that there is a relationship between the gut and the brain that is more than correlational.
In light of this unexpected link, new treatments are starting to emerge that focus on improving gut health to treat symptoms of mental illness. Probiotic treatments to help increase the number of good bacteria in the gut can have far-reaching effects on the brain and body. These benefits include lowering stress reactivity, reducing inflammation and cortisol levels, improving memory function, and even reducing symptoms of depression, anxiety, and neuroticism. A small number of human clinical trials show great promise for the use of pre- and probiotic treatment for environmentally induced depression and anxiety, which is mediated by metabolic, hormonal, and immune pathways. Furthermore, fecal transplantation, a procedure usually used to treat antibiotic resistant gastrointestinal disease, has been used to alter the microbiomes of children with autism spectrum disorder, improving both behavioral symptoms and gastrointestinal problems that commonly accompany the disorder.
Perhaps the most remarkable findings in this field come from several case studies of patients with chronic schizophrenia, one of the most devastating mental illnesses that affects approximately 1% of the population. In 2007, a physician reported two patients whose catatonic symptoms responded to an antibiotic called minocycline. Most likely, the antibiotic treatment altered the microbiome, in turn affecting the immune system and decreasing inflammation in the brain, thereby lessening symptoms. More recently there have been reports of two other patients who experienced complete remission of their schizophrenia after switching to a ketogenic diet and were able to stop taking antipsychotic medication entirely. The ketogenic diet is known for its metabolic benefits and has been used as a treatment for epilepsy for a while, but its potential to lessen symptoms of psychiatric disorders is a new discovery worthy of serious consideration.
Although this field of research is new and much evidence comes from animal models and case studies of human patients, the existence of a link between the gut and the brain is undeniable. In light of these findings, we are forced to consider how our medical and psychiatric practices have so far failed to treat the body holistically, and to reevaluate the way we deal with mental and physical illness. In a time of mental health awareness hashtags and a calculated effort by the younger generations to fight stigma, there remains a clear and pervasive discrepancy between the huge impact we know that mental health problems can have on our lives and the resources we devote to addressing them. Research that truly recognizes the inseparability of the mind and body has the potential to change that, but the change must happen at every level – in our language, in our thinking, and most importantly, in our medical practices.





