Back in February 2019, I invited my clients to volunteer in a clinical trial that I was participating in. The clinical trial was conducted by The School of Health and Human Sciences at Southern Cross University.
Eligible participants of the trial had to be assessed to meet the criteria of physiological distress and gastrointestinal symptoms.
The format of the trial was clinician based. I used my clinic to set up appointments, assessments and distribute the supplements.
As an n of 1 trial it offered a unique opportunity for one client to have a detailed treatment plan with supplementation. It allowed me as a practitioner to give someone who has possibly struggled long term with their mental health support, treatment and assessment.
The trial was a random triple blinded placebo; where the co-ordinator, practitioner and client were unaware when the placebo was used.
The client, aged 38, was already under medical treatment for anxiety. She had suffered with bouts of anxiety, burnout and mild depression for more than 15 years. Initially, this was an issue for the academic and ethics team supervising the trial. As they did not want to risk any complications and possible interactions. Ideally, the study interventions should also be the only intervention. However, I assured the team that even though she was medicated she was stable but still suffered continual bouts of psychological distress. She also presented with bloating and constipation for most of her adult life.
All participants were scaled on not just their mental health but also needed to fit the second criteria of suffering digestive dysfunction. The presence of both psychological distress and digestive dysfunction is consistent with the theory of the “Brain/Gut Axis”.
Insights into the gut-brain connection have revealed a complex communication system that not only ensures the proper maintenance of gastrointestinal health, but is likely to have multiple effects on affect, motivation, and higher cognitive functions. This is why individuals who suffer with mental illness are likely to have symptoms of irritable bowel syndrome or other digestive conditions. In the case of my study client she suffered long term constipation.
GLUTAMINE: is a conditionally essential amino acid. It is often referred to the “Thinking persons amino acid” as it has an affinity to mood and cognitive function. Glutamine is shown to be reduced in times of stress. Glutamine is also shown to heal the lining of the small intestine, reducing permeability and inflammation.
The role of glutamine in supporting mental health is its vital role in assisting the metabolism of Gamma Amino Butryic Acid (GABA). GABA keeps our nervous system in the “rest and digest” rather than the “Fight or Flight”. Glutamine acts as an antioxidant during times of metabolic stress.
Previous studies have shown that deficiencies in glutamine in the prefrontal cortex are possibly linked with depressive symptoms. Past studies, however, were on animal models and did not use other complementary supplementation supporting the brain-gut axis to enhance the glutamine/glutamate pathways.
The glutamine used in the trial was part of a formulated complex which also contained larch. Larch is a prebiotic that supports the ability of beneficial intestinal flora to replicate. Prebiotics enhance the function of probiotics.
PROBIOTICS: all participants were required to give stool samples, before the supplementation and after. My client showed increased levels of clostridium, zonulin and low levels of lactobacillus. These results are consistent with the knowledge that suffers of mood related disorders do have an imbalance of intestinal microbiome. The probiotic intervention was a combination of different species: lactobacillus animalis ssp Lactis (bb-12), Lactobacillus rhamnosus LGG and saccharomyces cerevisiae(boulardii). This specific combination allows the negative species such as candida and clostridium to deplete and allow the positive species namely lactobacillus to flourish.
FISH OIL (EPA/DHA): there are a several reasons why fish oil would be prescribed in cases of psychological distress. Firstly, the brain has a strong affinity to essential fatty acids, deficiencies in omega -3 fatty acids have long been associated with depression, anxiety and behavioural disorders.
Fish oil is known to have many beneficial side effects, and previous clinical trials demonstrate that supplementation with fish oil is beneficial in the management of depression. Fish oil contains omega-3 polyunsaturated fatty acids (PUFA), and there are several mechanisms by which PUFAs are thought to induce an antidepressant effect, including anti-inflammatory action on the brain itself.
Secondly, as omega -3 is absorbed in the gastrointestinal tract, it reduces systemic inflammation of the gut. Therefore; if the brain and the gut are intertwined in determining our mental health, Supplementation of fish oil is just as vital as probiotics.
Symptoms of constipation and bloating can be a symptom of omega-3 fatty acid deficiency as the digestive system lacks the lubrication of essential fats to effectively pass motions.
The standard Australian diet, is endemically low in essentially fatty acids, particularly EPA/DHA found in fish oil. Supplementation for many is required to optimize their health and wellbeing.
Fish oil has had some of the most extensive research conducted, often with unconvincing results. The problem may have been in poor quality and insufficient dosage of EPA/DHA. Many studies only used 1 gram of EPA/DHA. The study we conducted used in 4.2 grams of liquid fish oil.
The client was required to give blood and stool samples before and at the end of the study trial. During the study she was required to fill out questionnaire scales evaluating her mood, stress and gastrointestinal function. The outcomes were not just statistically viable, but the client felt not just stable but well and energetic.
The combination of high doses of fish oil and glutamine are shown to have a positive effective in reducing systemic inflammation of the digestive and nervous systems. Historically, such inflammation may have negatively impacted the client’s mental health, digestive and energy levels.
The stool tests revealed interesting data that concluded the positive association with the microbiome and the Brain/Gut axis. For example, the baseline tests showed low levels of lactobacillus 46.9 (CFU) and the end tests were up to 4508.4 CFU. The baseline tests showed high levels of clostridium and the end tests they were within normal range. This is solid evidence that probiotics used correctly can effectively alter the microbiome and benefit the patient across a number of medical conditions.
The Role of the Nutritionist in mental health
As a practitioner of complementary medicine, it is not my role to alter or change prescribe medications. My role is to improve their quality of life outcomes this can include the following common complaints:
Maintain positive body composition
Heal the gastrointestinal system
Optimise cognitive function
Encourage positive relationship between diet and cognitive function
The interventions used in the clinical trial have certainly shown their therapeutic benefit. Outside the supplementation there are other factors that should be considered. I honestly believe that my client benefited from coming to see me once a month. During the consultation the client had to answer questions regarding her mental and physiological wellbeing. It is too often that I see people who are medicated for mental health issues but do not have regular therapy, medical checks or nutritional support. I am not trained in psychology but the process of just sitting with a practitioner and discussing changes, positive or negative in how someone is coping is clearly beneficial. Possibly, even been given the chance to being heard is of benefit.
My positive conclusions in participating in this unique trial are extensive. Firstly, I would like to encourage anyone who struggles with their mental health to look for nutritional support. It is not going to interfere with your medical treatment plan, it could in fact improve quality of life outcomes for medicated individuals.
Secondly, the benefit of clients feeling comfortable to be transparent about their physical and emotional state is vital. It is not about been “a shrink”, its about being present and offering empathy.
Lastly, I really encourage fellow practitioners to engage in research. What we can offer in our practice can give validated evidence that could change the way people are treated for common illnesses.