Thursday, April 14, 2011

More Gut Feelings

As you read this blog, many patients are being told in a polite way that their intestinal problems “are all in your head.” Docs are trained not to say it quite like that; instead they may say “functional” pain, as they often describe psychosomatic issues in their journals.[1] While it is true that the brain influences gut function, the refusal to consider that the gut influences the brain is an issue that needs to be addressed to provide health care in keeping with good science.

If the brain influenced the gut and not vice versa, this would be the only example of unidirectional influences in Physics. Everything in the known Universe, including our body, attests of bidirectional influences; we live in a holistic network of living and inert matter. So, attempting to highlight how the gut and the food we eat influence brain function and behavior should not be construed as minimizing the power of the brain, behaviors and beliefs contributing to intestinal symptomatology and disease, and, of course, health.

Perhaps the greatest illustration of the bidirectional nature of the brain-gut connection is the Vagus nerve. You may “vaguely” remember from Biology 101 that the Vagus nerve is a “Cranial” nerve, or a nerve that exits the skull to talk to the gut, or more specifically, the stomach. Perhaps we should reconsider such “unidirectional” classification: it turns out that 2/3 of the neuronal axons or tails composing this nerve originate in the stomach and travel upward to the brain…

Could it be that the emphasis on the brain controlling the gut is a sneaky side effect of the belief that logic and the intellect (the brain) are superior to feelings and intuition (the gut)? Could it be that our male-dominated society has subconsciously minimized our feminine nature, even in science and health issues? These are questions we need to entertain to heal the problems that not only beset Health Care, but all other aspects of our society. To think that these statements minimize logic, the intellect and for that matter the goodness of our masculine nature is to miss the point and continue to wallow in a polarized illusion that denies the holistic nature of our souls and the Universe itself.

It would be wiser to manage patients with gut issues such as Ulcers, Colitis and Irritable Bowel Syndrome by keeping in mind that the brain and the gut influence each other,just like a marriage. Since I am not an expert in the latter, I will now step out of the way to let you read a few articles hot off the press that, when strung together, tell a compelling story of bidirectional influences. I hope you take the time to draw your own conclusions.

“How Food Governs Circadian Behaviors,” PNAS March 29th 2011 Epub

“Normal gut microbiota modulates brain development and behavior.” Accepted by the Editorial Board of PNAS January 4, 2011

"Microbial colonization of mammals is an evolution-driven process that modulate host physiology, many of which are associated with immunity and nutrient intake. Here, we report that colonization by gut microbiota impacts mammalian brain development and subsequent adult behavior. Using measures of motor activity and anxiety-like behavior, we demonstrate that germ free (GF) mice display increased motor activity and reduced anxiety, compared with specific pathogen free (SPF) mice with a normal gut microbiota. This behavioral phenotype is associated with altered expression of genes known to be involved in second messenger pathways and synaptic long-term potentiation in brain regions implicated in motor control and anxiety-like behavior. GF mice exposed to gut microbiota early in life display similar characteristics as SPF mice, including reduced expression of PSD-95 and synaptophysin in the striatum.

Hence, our results suggest that the microbial colonization process initiates signaling mechanisms that affect neuronal circuits involved in motor control and anxiety behavior

“Rifaximin (antibiotic) Offers Symptom Relief for IBS Without Constipation, “Journal Gastroenterology 2011;140:1119

“The FDA to investigate the effect of food additives on ADD,” March 30th 2011

“The long shadow cast by childhood physical and mental problems on adult life," Journal Proceedings of the National Academy of Science Epublished March 28, 2011

Large effects are found due to childhood psychological problems on the ability of affected children to work and earn as adults and on intergenerational and within-generation social mobility. Adult family incomes are reduced by 28% by age 50 y, with sustained impacts on labor supply, marriage stability, and the conscientiousness and agreeableness components of the “Big Five” personality traits. Effects of psychological health disorders during childhood are far more important over a lifetime than physical health problems.”

“Abuse, Trauma, and GI Illness: Is There a Link?” Am J. Gastroenterology 2011;106: 14

“Metabolic Syndrome and Onset of Depressive Symptoms in the Elderly: Findings from the Three-City Study,” J. Diabetes Care April 2011 34:9

“Metabolic Syndrome and Cognitive Decline,” J. Neurology 2011;76:518

“Rapid metabolic evolution in human prefrontal cortex,” J. PNAS published ahead of print March 28, 2011

“The Effects of Weight Loss Versus Weight Loss Maintenance on Sympathetic Nervous System Activity and Metabolic Syndrome Components,” J. Clin Endocrinol Metabolism 2011 96: E503

“Low-Grade Hypothalamic Inflammation Leads to Defective Thermogenesis, Insulin Resistance,and Impaired Insulin Secretion,” J. Clin Endocrinol Metabolism 2011 96: 869

“Metabolic Syndrome and Onset of Depressive Symptoms in the Elderly: Findings from the Three-City Study,” J. Diabetes Care April 2011 34:9

“Diabetes and Risk of Parkinson’s Disease,” J. Diabetes Care April 2011 34:910


Neurogastroenterology: A Great Career Choice for
Aspiring Gastroenterologists Thinking About the Future
,” Journal
Gastroenterology 2011;140:1126


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