Author name: laura@lauracipullo.com

Obsessive-Compulsive Disorder and Eating Disorders: Understanding the Intersection By Rebecca Jaspan, MPH, RD, CDN, CDCES   When you have an eating disorder, it is not unusual for you to also struggle with other mental health issues.  These may include depression, generalized anxiety disorder, post-traumatic stress disorder, and obsessive-compulsive disorder.1  Studies show that about two-thirds of individuals with eating disorders also have a co-occurring anxiety disorder.  Studies also show that those diagnosed with anorexia nervosa or bulimia nervosa are anywhere from 11 to 69% more likely to develop OCD.  It is believed that eating disorders and OCD share traits that contribute to their development and account for the high rate of comorbidity.2     As its name implies, those who have obsessive-compulsive disorder struggle with either obsession, compulsions, or more commonly both.  Obsessions are recurrent and frequent thoughts and impulses that intrude on your daily life and often cause distress and anxiety.3  An individual usually attempts to ignore, suppress, or stop the thoughts by doing another action or thought, which becomes the compulsion.  Compulsions are repetitive behaviors or mental acts that are performed in response to an obsession.4  Common compulsions are hand washing, repeated checking, counting, or repeating words.   People with eating disorders can present with many similar symptoms that are characteristically similar to the symptoms of OCD.  Specifically, people with eating disorders may experience repetitive thoughts about food and body engage and engage in ritualistic behaviors that may cause distress if they do not engage in the behavior.  Common ritualistic behaviors in eating disorders include body checking, weighing frequently, avoiding foods associated with fear of weight gain, and engaging in rituals around food intake, such as cutting food into tiny pieces or eating foods in a certain order.   The important distinction between OCD and eating disorders lies in the relationship that the individual has with their thoughts and actions.  A person with OCD finds their obsessions and compulsions in conflict or aversive to their identity and values.  In an eating disorder, the person typically feels aligned with their thoughts and behaviors.  Individuals with OCD are typically highly interested in stopping their obsessions and compulsions, where someone with an eating disorder may feel more tied to these thoughts and behaviors and have more trouble uncoupling them from their identity.  Losing these thoughts and behaviors may feel extremely distressing and like a part of their identity is being taken away.  This distinction is imperative as it drives the difference in the treatment process.   Because both eating disorders and OCD share some overlapping diagnostic characteristics, treatment for both in the form of exposure therapy is helpful.  Exposure therapy involves exposing the client to the feared stimulus, for example, a food that is feared, having dirty hands, or not getting on the scale, in order to help them gradually build a tolerance to their fear and develop a new association.  In eating disorder treatment, the client is mainly exposed to food or stressful situations surrounding food.  In OCD treatment, the client would not only be exposed to food, but also would be coached through refraining from any rituals around food in which they may compulsively engage.   Additionally, cognitive treatment varies across the disorders.  Individuals with OCD recognize that their obsessions are irrational, but have difficulty coping with these thoughts.  Conversely, individuals with eating disorders tend to struggle to see the distortions in their thinking.  Cognitive behavioral therapy (CBT), which includes identifying and challenging cognitive distortions, is commonly used in the treatment of eating disorders.  Acceptance and commitment therapy (ACT), which focuses more on changing the person’s relationship to their thoughts and feelings, is more appropriate for a person who struggles with OCD.  It is important to note that both types of therapy can be used in either disorder as well.   Working together, the therapist, dietitian, and psychiatrist on the treatment team can identify the overlap of these disorders and help the client recognize their behavior patterns.  Identifying the similarities, differences, and interventions is an important aspect of treatment for both disorders.     References: Anxiety and Depression Association of America. Anxiety, depression & obsessive compulsive disorder. Neziroglu F. International OCD Foundation. The relationship between eating disorders and OCD part of the spectrum. Anxiety and Depression Association of America. Obsessive-compulsive disorder (OCD). American Psychiatric Association. What is obsessive-compulsive disorder?.      

Eating Disorders in the LGBTQ+ Community: Challenges and Support Strategies     By Reva Schlanger MS, RD, CDN   Contrary to previous thought, eating disorders are not unique to straight, cisgender women. They cut across all social categories, including sexual orientation and gender identity. LGBTQ+ identified folks experience unique stressors that may contribute to the development of an eating disorder. While there is still much research to be done on the relationships between sexuality, gender identity, body image, and eating disorders, we know that eating disorders disproportionately impact some parts of the LGBTQ+ community. LGBTQ+ people face unique challenges that may put them at greater risk of developing an eating disorder. Research shows that, beginning as early as 12 years old, gay, lesbian, and bisexual teens may be at higher risk of binge-eating and purging than heterosexual peers.   Recent research has come out focusing on the LGBTQ+ community and its high prevalence rates of eating disorders. In fact, research suggests that some LGBTQ+ community members experience eating disorders at even higher rates than their straight and cisgender counterparts. In one study, 54% of LGBTQ+ adolescents and young adults surveyed indicated that they had a diagnosed eating disorder, and an additional 21% suspected that they had an eating disorder.1 Men who identify as gay are thought to represent 5 percent of the total male population, but among males who have eating disorders, 42 percent identify as gay.2 People who identify as gay, lesbian, bisexual, or “mostly heterosexual” experience elevated rates of binge eating and purging as compared to their heterosexual peers.3 Like eating disorders in other populations, eating disorders in the LGBTQ+ community are complex and multifactorial. Sexual or gender identity alone does not predict who will develop one, as other physiological, social, and biological factors also play a big part. Experiences related to sexual orientation and gender identity can, however, contribute to the development or maintenance of an eating disorder. Factors that may increase the likelihood of an eating disorder in a susceptible LGBTQ person include: Discrimination, harassment, and bullying related to sexual orientation or gender identity. Anxiety and fear of rejection or experience of rejections by friends, family, and co-workers Internalized homophobia, transphobia, or misogyny. Gender dysphoria experienced by trans and/or non-binary individuals Inability to meet body image ideals within some LGBTQ+ cultural contexts Experiences of violence and post-traumatic stress disorder (PTSD), which research shows sharply increases vulnerability to an eating disorder   LGBTQ+ people, in addition to experiencing unique contributing factors, may also face challenges for accessing treatment and support. Common barriers may include a lack of culturally competent treatment, which addresses the complexity of sexuality and gender identity issues, lack of support from family and friends, and insufficient eating disorders education among LGBTQ+ resource providers who are in a position to detect and intervene. The emergence of LGBTQ+ youth drop-in centers, gay-straight alliances, LGBTQ+ community centers, and LGBTQ+ healthcare resources have created more safe spaces to access support and mental health care. However, many LGBTQ+ people remain isolated in communities that do not offer such services/programs. Support is key to recovery for people of all gender and sexual identities. True support means caring for the whole person instead of just their illness. When supporting LGBTQ+ people with eating disorders, it is vital to affirm their gender and sexual identities and to recognize how these identities intersect with the experience of illness and recovery. Here are some strategies to provide support that is safe, inclusive, and affirming for LGBTQ+ community members with eating disorders. 1. Center LGBTQ+ voices and experiences. Start by simply listening to LGBTQ+ people about their relationship with food and their bodies. Remember that each person is the expert of their experience, and any support offered should respect their individuality and guidance on what is and is not helpful.   Some practical tips for actively listening and learning include: Create a safe space for people to share what they need, making it known that you will listen with confidentiality and without judgment. Ask how you can help by using questions like: What can I do? Would you like to research LGBTQ+-friendly treatment options together? Would it be helpful to share a meal? What isn’t helpful? Read and listen to the experiences of people in the LGBTQ+ community, understanding that there is no singular story. 2. Affirm each person’s identity through inclusive language. Adopt language that affirms all gender and sexual identities. Introduce yourself with your name and pronouns and ask others for theirs. Practice using gender-neutral terms (e.g., “everyone”) in place of gendered ones (“men and women”). Create intake forms that don’t assume sexual or gender identity. 3. Acknowledge the intersection of eating disorders and LGBTQ+ identities.  Eating disorders can affect the LGBTQ+ community in unique ways. Recognize that special factors may play a role in the development and maintenance of these illnesses in this population, including: Eating disorders being overlooked or dismissed across the LGBTQ+ community because they do not fit the stereotype. Discordance between body and gender identity among trans and/or non-binary people that can trigger disordered behaviors to improve body dissatisfaction or distress An elevated drive for muscularity among gay men that can introduce or exacerbate eating disorder symptoms 4. Appreciate that recovery is not one size fits all. Eating disorder recovery looks different for everyone, and several mainstream recovery messages may be particularly out of touch with the experiences and needs of LGBTQIA+ people. When providing messages of support, be wary of: Messages championing total body positivity (e.g., “Your body is perfect the way it is!” “Love the skin you’re in!”), which can be invalidating for those experiencing gender dysphoria. Messages celebrating the return of menses, which can be dysphoric for trans and non-binary individuals. Heteronormative and patriarchal messages meant as motivation in recovery (e.g., “Guys like women with curves.”). 5. Support efforts toward greater inclusion and diversity. LGBTQ+ individuals face unique barriers to eating disorder treatment and ensuring that the community has access to care is ongoing work. Support efforts

What is Mindfulness? Understanding and Practicing Presence By Rebecca Jaspan, MPH, RD, CDN, CDCES What does mindfulness mean? The word “mindfulness” is thrown around often and the practice of mindfulness has gained popularity.  What does it mean to be mindful?  What does it actually mean to practice mindfulness?  According to the dictionary definition, mindfulness is “the quality or state of being conscious or aware of something”.  It is also “a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations.”   While mindfulness sounds pretty straightforward, achieving mindfulness can be very challenging.  We frequently move quickly throughout our day, attending to different tasks and racing thoughts.  We may get caught up with what’s in our head that we lose touch with our bodies, which can lead to anxiety about the past or future.  Many of us move through the world on autopilot without taking the time to notice the sights, sounds, smells, and connections around us.   Mindfulness is a tool to bring us back to the present moment, even if just for a minute, to help cope with anxiety and overwhelm that may come up in our daily lives.  Mindfulness transforms how we relate to events and experiences, helping us to become less reactive and overall happier.  While it may feel impossible to be mindful, just like any skill, it takes practice and we need to learn how to access it when we need it.   Why should we practice mindfulness? When we are mindful, it helps to reduce stress, enhance cognitive and physical performance, gain insight and awareness of our own mind, and increase our attention on the well-being of others.1  A goal of mindfulness is to suspend judgment of our own thoughts and feelings and unleash our natural curiosity, both about what is going on in our minds and in our bodies.  You can acknowledge the thought or feeling without needing to explore it further.   There are many different types of mindfulness practices and it may take many tries for you to find what works best for you.  You can be seated, walking, standing, or even moving.  You can practice short pauses built into your everyday life.  Or you can merge meditation practices with other activities, such as yoga, jogging, or other sports. How to practice mindfulness When first beginning the practice of mindfulness or meditating, you may get caught up in your thoughts or trying to change your thoughts.  Instead, try think about meditation beginning and ending in your body.  Bring awareness to your body and its internal rhythms without judgment, That in itself can be very calming.  By doing this regularly, you will notice a shift from reacting automatically in a negative or unhelpful way to observing instead of reacting.  This shift helps to create a pause and you can choose a more effective response. There is no right way to practice mindfulness and you may need to try many different techniques before finding something that sticks with you.  Interested in developing a mindfulness practice?  Talk to your LCWNS dietitian and we can give you some tools and resources to start today.   References: Hofmann SG, Gómez AF. Mindfulness-Based Interventions for Anxiety and Depression. Psychiatr Clin North Am. 2017;40(4):739-749. doi:10.1016/j.psc.2017.08.008

Five Mindfulness Practices to Start Today for Enhanced Well-being By Reva Schlanger MS, RD   Lately, the term mindfulness has been ubiquitous. We throw that word around a lot, but how many of us actually know what mindfulness means or how to apply it to daily living? Simply put, mindfulness is the ability to stay in the present moment and focus our thoughts on what is happening in the here and now. It’s our ability to not think about the past or future but instead to observe what is happening in the moment. Sounds simple enough, however many people find achieving a state of mindfulness extremely difficult. Unfortunately, in today’s world we are bombarded with distractions that take our attention and focus elsewhere. Many of us are addicted to technology and have less ability to focus our attention for a long period of time. This is a problem as it inhibits us from practicing mindfulness and slowing down. There are many positive benefits like reducing anxiety and depression, relieving chronic pain, improving sleep, and reducing stress. Ultimately, it can help us cultivate to lead happy and meaningful lives centered in the present. If mindfulness has been a goal but seems daunting, here are some five simple practices to start today!   Practice gratitude This practice can take about 5 minutes of your day but have lasting benefits. When we practice gratitude, we must focus our attention on the positives in our lives, in the present moment. It helps bring the good stuff to the forefront of our mind so that we can come back into the now moment, instead of worrying about the future or ruminating over the past. By focusing on the positive, we can become more present and available to create a more positive future. To start off, list 5 things you are grateful for in this moment. It can help to write it down in a journal and allow you to come back and reflect over it at a later time.   Fire up your five senses One of the simplest ways of staying mindful is to bring your attention to the present moment. Stop what you are doing for a moment and observe what is going on around you. What noises do you hear? What scents do you smell? What does the air feel like? What are others around you doing? Wherever you are, whatever you’re doing, put your full attention there and observe it through your five senses for a few moments to practice bringing your mind to the now moment.   Check in with your body Our bodies function daily without our participation. Think about it, we breath automatically, our heart beats continuously and bodily functions happen regardless of what we do. Our body does try to communicate with us by sending us messages through sensations in the body. Take a moment (or two) to check in with your body. What do you notice? Where are you holding tension? Do you have aches or pains? Are there places you feel worse than others? Brining our attention to our bodies can help realign our attention to the present and connect us to the information needed to take better care of ourselves.     Focus on your breath Another access point to bringing our attention to the moment is by focusing on our breath. The breath is happening with or without our conscious awareness, but by bringing our attention to our breath we can help our mind focus. Notice how you are breathing. Is it shallow or deep? Take five deep belly breaths and focus your attention on your inhale and exhale. Repeat that three times and practice it multiple times during the day.   Mindful Eating Another time to focus on the present moment is when we eat. Most of the time we aren’t paying attention to the food we eat because we’re eating at our desk, watching a show/movie, or reading while we eat. But research has shown that when we eat with more mindfulness, we digest our food better which helps get more vitamins and minerals and aids in overall digestive health. It can also help us with pacing and taking the time to enjoy our food and feel satisfied. So next time you sit down for a meal, put down the phone, chew your food mindfully and notice how you eat. Do you eat fast or slow? Do you chew your food or inhale it? What does your food taste like? If this seems like a daunting task, it may be time to reach out to a Registered Dietitian for help. Here at Laura Cipullo Whole Nutrition Services, we can help guide you towards a daily mindful eating practice.     References: Enkema MC, McClain L, Bird ER, Halvorson MA, Larimer ME. Associations between mindfulness and Mental Health Outcomes: A systematic review of Ecological Momentary Assessment Research.Mindfulness. 2020;11(11):2455-2469. doi:10.1007/s12671-020-01442-2 Gilbert D, Waltz J. Mindfulness and health behaviors.Mindfulness. 2010;1(4):227-234. doi:10.1007/s12671-010-0032-3 Cho H, Ryu S, Noh J, Lee J. The effectiveness of daily mindful breathing practices on test anxiety of students.PLOS ONE. 2016;11(10). doi:10.1371/journal.pone.0164822 Warren JM, Smith N, Ashwell M. A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: Effectiveness and associated potential mechanisms.Nutrition Research Reviews. 2017;30(2):272-283. doi:10.1017/s0954422417000154  

Yoga’s Healing Role in Eating Disorder Treatment: A Path to Mind-Body Harmony By Rebecca Jaspan, MPH, RD, CDN, CDCES   An individual with an eating disorder is in a state of conflict with their physical selves.  Often the beginning steps in treatment involve helping you to feel more at home in your physical body, trusting your feelings and body sensations, and translating that into information about your unique experiences in the world.  Yoga helps support a connection between what you are feeling in your body and grounding your thoughts to the present moment.   So, what is yoga?  Many of us associate yoga with a number of physical postures and poses done on a mat.  In addition to the physical movements, yoga also involves a mental and spiritual practice, focusing on mindfulness and breathwork.  The practice aims to create union between body, mind, and spirit.1   For many with an eating disorder, being asked to sit with their body and breath can feel extremely uncomfortable.  Yoga helps clients learn to sit with and push through their discomfort and do their best to stay in the present moment.  They are asked to notice their thoughts and feelings without placing any judgement on them.  Yoga offers a safe avenue for individuals with eating disorders to engage in physical activity and offers them a new and different way to move their bodies.  Many individuals find they gain a deeper sense of being present without ruminating about the past or future.  Additionally, they become more in tune with their bodies and find acceptance and compassion toward themselves and their bodies.  They also gain a greater ability to listen to and respect their body’s needs.   More and more inpatient and outpatient eating disorder treatment centers are using yoga as part of their programs. Research shows a strong relationship between the use of yoga therapy and improvement in eating disorder symptoms. One study looked at the use of a yoga practice in the outpatient setting and its impact on anxiety, depression, and body image disturbance in adolescents with eating disorders.  Twenty adolescent girls, ages 14-18, were recruited from an eating disorder clinic and they participated in 12 weekly yoga classes in addition to standard multidisciplinary care.  The participants completed a questionnaire about anxiety, depression, and body image disturbance before their first class and after completion of 6 and 12 classes.2   After the completion of 12 weeks, there was a statistically significant decrease in anxiety, depression, and body image disturbance.  Yoga combined with outpatient eating disorder treatment shows to be a promising adjunct treatment strategy.2   As our name suggests, your dietitian at Laura Cipullo Whole Nutrition and Yoga believes the practice of yoga and certain elements of yoga, such as breathwork and mindfulness, are important tools in eating disorder recovery.  Talk to your dietitian about incorporating a yoga practice into your treatment plan.   References: Arora S, Bhattacharjee J. Modulation of immune responses in stress by Yoga. Int J Yoga. 2008;1(2):45–55. doi: 10.4103/0973-6131.43541. Hall A, Ofei-Tenkorang NA, Machan JT, Gordon CM. Use of yoga in outpatient eating disorder treatment: a pilot study. J Eat Disord. 2016 Dec 9;4:38. doi: 10.1186/s40337-016-0130-2. PMID: 27980773; PMCID: PMC5148831.  

Eating Patterns Beneficial for Your Gut Microbiome: Insights and Recommendations   By Rebecca Jaspan MPH, RD, CDN, CDCES   The gut microbiome is an important factor in human health and more and more research is showing its role in the prevention of chronic diseases.  Dietary habits are linked to changes in the gut microbiome that are thought to contribute to diseases such as diabetes, irritable bowel syndrome, atherosclerosis, and asthma.  Additionally, the gut microbiome plays a crucial role in helping control digestion and promoting a healthy immune system.1 Researchers are increasingly interested in studying the variation of dietary patterns in the general population to identify which components are best associated with a healthy gut microbiome and positive health outcomes.2   So, what makes a healthy gut microbiome?  The gut microbiome is made up of bacteria, viruses, and fungi that live throughout the digestive tract and on your skin.  There are about 1,000 different species bacteria in the human gut microbiome and each plays a different role in your body.3  Research shows that a diverse microbiome is associated with lower chronic disease rates and a loss of microbiota diversity is the most consistent finding of intestinal dysbiosis, or unbalanced microbiota.4  This suggests that reintroducing bacterial diversity into the digestive system is imperative for improving or restoring gut microbiome diversity.  Decreased microbial diversity also predicts the response to treatments of certain conditions. For example, in a study looking at children with ulcerative colitis, those with a more diverse microbiota responded better to corticosteroids.5   A question both researchers and clients ask often is what type of eating pattern is shown to have the greatest impact on the health of the gut microbiome.  In a study published in February 2022, the researchers explored the contribution of the long-term diet by looking for dietary patterns that are best associated with a healthy gut microbiome in a population-based cohort.  Previous studies looking at diet quality and the gut microbiome use priori approaches, or knowledge based on hypotheses instead of actual experience.  This study is unique because it used both priori and posteriori approaches, which looked at results from hypotheses and lived experience from the participants.6   The study recruited 1800 participants and gathered human microbiome data long with demographics, lifestyle, and dietary data.  The participants informal dietary questions and also completed a Food Frequency Questionnaire. The researchers looked for associations between dietary patterns and 16S rRNA gene-based gut microbiome profiles.6   After looking at 61 dietary patterns, the researchers found that larger amounts of plant foods and fewer amounts of animal foods were associated with a better overall diet quality.  Additionally, they found that the Flexitarian eating pattern, which consists of high amounts of fruits, whole grains, nuts, in addition to meat and high amounts of dairy products, had higher gut microbiota diversity.  The study did not find any significant data to support individual foods or nutrients contribute to greater gut microbiota diversity.6   Overall, this study concluded that a global approach to eating patterns explains gut microbiota variations rather than single nutrient data.  It also observed that a higher intake of plant protein compared to animal protein was positively associated with Bifidobacterium, or good bacteria, in our gut.  However, the study does not show any evidence for eliminating any food from the diet to achieve a diverse and healthy gut microbiome.6   The study did contain several limitations.  First, the dietary intake of the participants was self-reported and measured by FFQ, which may have inherent measurement error and bias.  Additionally, a causal relationship between diet and gut microbiota cannot be determined with the cross-sectional design of the study.  Also, due to country-specific guidelines, the study results are not generalizable across countries and populations.6   Despite the study’s limitations, it gives good insight into the different types of eating patterns that may contribute to a healthy and diverse gut microbiome.  While there are benefits to eating more plant-based foods, research does not support eliminating meat and dairy.  In fact, fermented dairy foods such as yogurt and kefir are shown to have benefits for the gut microbiome.  The best eating pattern for gut health is one that contains a wide variety of all foods, in addition to lifestyle factors such as good sleep, movement, and stress management.  Need help finding an eating pattern good for your gut?  The dietitians at LCWNS can assist you in creating the most diverse eating pattern possible to support your gut health.     Resources: Zinöcker MK, Lindseth IA. The Western Diet-Microbiome-Host Interaction and Its Role in Metabolic Disease. Nutrients. 2018;10(3):365. Published 2018 Mar 17. doi:10.3390/nu10030365 Cotillard A, Cartier-Meheust A, Litwin NS, Chaumont S, Saccareau M, Lejzerowicz F, Tap J, Koutnikova H, Lopez DG, McDonald D, Song SJ, Knight R, Derrien M, Veiga P. A posteriori dietary patterns better explain variations of the gut microbiome than individual markers in the American Gut Project. Am J Clin Nutr. 2022 Feb 9;115(2):432-443. doi: 10.1093/ajcn/nqab332. PMID: 34617562; PMCID: PMC8827078. Integrative HMP (iHMP) Research Network Consortium. The Integrative Human Microbiome Project: dynamic analysis of microbiome-host omics profiles during periods of human health and disease. Cell Host Microbe. 2014;16(3):276-289. doi:10.1016/j.chom.2014.08.014 Jalanka-Tuovinen J, Salonen A, Nikkilä J, et al. Intestinal microbiota in healthy adults: temporal analysis reveals individual and common core and relation to intestinal symptoms. PLoS One. 2011;6(7):e23035. doi:10.1371/journal.pone.0023035 Michail S, Durbin M, Turner D, et al. Alterations in the gut microbiome of children with severe ulcerative colitis. Inflamm Bowel Dis. 2012;18(10):1799-1808. doi:10.1002/ibd.22860 Cotillard A, Cartier-Meheust A, Litwin NS, Chaumont S, Saccareau M, Lejzerowicz F, Tap J, Koutnikova H, Lopez DG, McDonald D, Song SJ, Knight R, Derrien M, Veiga P. A posteriori dietary patterns better explain variations of the gut microbiome than individual markers in the American Gut Project. Am J Clin Nutr. 2022 Feb 9;115(2):432-443. doi: 10.1093/ajcn/nqab332. PMID: 34617562; PMCID: PMC8827078.    

The Gut-Brain Connection: Nurturing Mental and Digestive Health By Rebecca Jaspan, MPH, RD, CDN, CDCES Have you ever had butterflies in your stomach from nervousness or excitement? Or have you ever heard of having a gut feeling? These feelings and sensations are not only expressions, but actually suggest that the gut and brain are connected. Recent research shows that the health of your gut may affect your brain and vice versa, your brain may affect your gut health. Most of this evidence comes from the dysbiosis, or disruption to the microbiota balance, in the gut that is associated with central nervous system disorders and gastrointestinal disorders.1 The health of the gut-brain connection may be improved through a number of different ways, including the foods we eat and stress management techniques. What is the gut-brain axis? The gut-brain axis is the communication system between your gut and your brain. This system links emotional and cognitive centers of the brain with peripheral intestinal functions. A better understanding of the relationship between the brain and gut may help provide targeted therapies and treatments for a number of gastrointestinal and mental health disorders such as irritable bowel syndrome, depression, and anxiety.1 The bidirectional communication network between the brain and the gut includes the central nervous system (CNS), spinal cord, the autonomic nervous system (ANS), the enteric nervous system (ENS), and the hypothalamic pituitary adrenal (HPA) axis. In response to any form of stress, these systems release cortisol, the major stress hormone that affects many organs, which influences the activity of intestinal and immune cells.1 These cells are largely affected by the gut microbiota, which is where our gut health comes into play.2 The gut microbiome is the diverse network of bacteria that resides in the human gut. Each person’s microbiota is distinct, though the abundance and distribution of the microbiota along the intestine is similar among health individuals. The most prominent bacteria in the gut are Firmicutes and Bacteroides, accounting for at least three-quarters of the microbiome. The presence of diverse gut microbiota has important metabolic and physiological functions.3 The final important component of the gut-brain axis is the vagus nerve, one of the largest nerves in the body that connects the brain and the gut. Your gut contains 500 million neurons and the vagus nerve helps send signals in both directions.4 The vagus nerve is thought to play an important role in both gut and brain health. One study found that individuals with irritable bowel syndrome or Crohn’s disease had reduced vagal tone, indicating that the function of the vagus nerve was reduced.5 Why is the gut-brain axis important? Research shows that chronic stress alters intestinal permeability. This is associated with low-grade inflammation and many health conditions including psychiatric disorders such as depression.6 There is increasing interest in determining how the gut microbiota may influence and contribute to the development and pathogenesis of neuropsychiatric disorders. For example, dopamine is a key neurotransmitter associated with schizophrenia. It is possible that bacterial metabolites in the gut interact with and stimulate the central and peripheral nervous system. It is also well established that the response of the central nervous system to psychological and physical stressors can affect gut homeostasis and contribute to the development of diseases such as ulcerative colitis and irritable bowel syndrome. Frequently, one primary treatment of irritable bowel syndrome is stress management along with dietary changes and possible medication.7 How do you improve the gut-brain connection? There is a large body of research to suggest that gut bacteria affect brain health, so altering your gut bacteria may improve your brain health. There are certain groups of foods that are beneficial for the gut-brain axis. Omega-3 fatty acids are found in oily fish such as salmon and tuna, flaxseed, walnuts, and plant oils. They are needed for brain health and studies show that they can increase the good bacteria in the gut, reducing the risk of brain disorders.8 Fermented foods such as yogurt, kefir, and sauerkraut, contain healthy gut bacteria and are shown to alter brain activity.9 Foods that are high in fiber such as whole grains, nuts, seeds, fruits and vegetables are considered prebiotics, which is food for the healthy bacteria in your gut. Research shows that prebiotics may reduce cortisol in humans.10 What about probiotics? Probiotics are live bacteria in the gut and research shows that the greater diversity of gut microbiota we have, the healthier our gut is. Probiotics may impart health benefits when eaten or taken as a supplement. There are also specific probiotics that are thought to affect the brain, called psychobiotics.11 Some probiotics have been shown to improve symptoms of stress, anxiety, and depression. One small study looked at individuals with irritable bowel syndrome and anxiety and depression. The study found that taking a probiotic for six weeks significantly improved symptoms.12 Think you may benefit from increasing gut healthy foods in your diet or taking a probiotic? Speak with your registered dietitian and they can help you come up with a plan that is specific to your individual needs. References: 1. Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol. 2015;28(2):203-209. 2. Mayer EA, Savidge T, Shulman RJ. Brain-gut microbiome interactions and functional bowel disorders. Gastroenterology. 2014;146:1500–1512 3. Eckburg PB, Bik EM, Bernstein CN, et al. Diversity of the human intestinal microbial flora. Science. 2005;308:1635–1638 4. Mayer EA. Gut feelings: the emerging biology of gut-brain communication. Nat Rev Neurosci. 2011;12(8):453-466. Published 2011 Jul 13. doi:10.1038/nrn3071 5. Pellissier S, Dantzer C, Mondillon L, et al. Relationship between vagal tone, cortisol, TNF-alpha, epinephrine and negative affects in Crohn’s disease and irritable bowel syndrome. PLoS One. 2014;9(9):e105328. Published 2014 Sep 10. doi:10.1371/journal.pone.0105328 6. Kelly JR, Kennedy PJ, Cryan JF, Dinan TG, Clarke G, Hyland NP. Breaking down the barriers: the gut microbiome, intestinal permeability and stress-related psychiatric disorders. Front Cell Neurosci. 2015;9:392. Published 2015 Oct 14. doi:10.3389/fncel.2015.00392 7. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/treatment 8. Menni C, Zierer J, Pallister T, et