Depression can start with a leaky gut — here’s how to make it end there
Itwould be foolish to believe that depression can be overcome with a single solution.
But for some people, the light at the end of the tunnel shines in a very surprising place.
It certainly did for me. Healing my depression came with healing my gastrointestinal tract—my gut.
When I became a nutrition student in 1992, I had a lot of healing to do. I had the irritable bowel from hell. No treatment had worked: not conventional medicine, nor the truly woo-woo stuff.
What I discovered, as a student, was that I had something called a “leaky gut”. Cue much hilarity at that.
The term leaky gut conjures up an image of cartoonish pseudoscience. But when given its scientific nomenclature — “intestinal permeability” — the idea immediately gains credibility.
Furthermore, the scientific evidence for the association between gut health and brain health is strong and gathering momentum.
What is a leaky gut? How can it lead to depression?
Your gut does much more than just digest your food and extract the goodies from it. It forms a protective barrier between your insides and the external world.
But the system has a weakness. This barrier — the gut lining — consists of just a single layer of cells, called the epithelium. The cells of this fragile layer are held together by proteins called “tight junctions”.
Like doormen carefully guarding your innards, these tight junctions sift out undesirable elements and block their entrance. Under normal circumstances, troublemakers are given short shrift and expelled from the gut in the normal way. These include toxins, undigested food particles, microscopic bugs and other foreign bodies that have found their way in via your food and drink.
Unfortunately, it’s easy to damage the epithelium, leaving it leaky. Microscopic holes appear and the tight junctions start to loosen. For the assortment of rabble able to cross into your bloodstream, it’s like having an all-access pass to the rest of your body.
Mayhem ensues, and it isn’t pretty.
Unsurprisingly, the symptoms of a leaky gut can show up anywhere, from the gut to the joints, from the skin to the brain.
I was proof of that. For 15 years, I lived with daily abdominal pain, often excruciating, accompanied by some extraordinary bloating and gas.
I could have lived with all that. But as a sensitive young adult, I could have done without the blemishes. Not, thankfully, on my face. But my chest and back were peppered. I was hugely self-conscious, and only wore clothes that covered up those areas. Summers could be tricky.
Part of the problem is — and certainly was, for me — toxic overload. The liver normally copes well with the body’s everyday toxins, but when the burden exceeds capacity, they get dumped elsewhere. In my case, it was skin.
Different people experience different symptoms. There are many conditions associated with a gut that has lost its integrity and become porous, including inflammatory bowel disorder, coeliac disease, arthritis, eczema, and, of course, acne.
Scientists have recently added depression to that list.
The link between depression and leaky gut is inflammation, and inflammation is one of the key characteristics of intestinal permeability. It is largely created by bacteria.
Bacteria belong in the gut, where they normally either stay put or move out. But when the gut is leaky, they are able to cross into the bloodstream (a process known as “translocation of bacteria”), where they release a toxic substance called endotoxin.
This endotoxin sets in motion an immune response. This response includes the production of inflammatory proteins called cytokines, and a substance called lipopolysaccharide (LPS).
There is growing evidence that cytokines and LPS can trigger major depression (MDD), also known as clinical depression. So much so that in 2008 Belgian researchers concluded, in a study published in the journal Neuroendocrinology Letters, that:
“Patients with MDD should be checked for leaky gut”.
Since then, the research into the link between gut inflammation and depression has continued. According to data from the National Health and Nutrition Examination Survey, an extraordinary 47% of people with clinical depression also have ‘heightened’ inflammation.
How does inflammation have this effect?
Cytokines are able to trigger depression by altering activity in the regions of the brain that control mood. They also cause damage in those regions.
This can result in feelings of negativity and fatigue, an effect that has also been observed in cancer therapy. Cytokine is used to treat some cancers and viral infections — and can trigger the onset of major depression in up to 45% of patients.
On the bright side…
Interestingly, researchers have found that that when clinical depression goes into remission, so too does inflammation.
Scientists describe these recent revelations as:
“A paradigm shift in neuroscience, with possible implications for not only understanding the pathophysiology of stress-related psychiatric disorders, but also their treatment”.
Something must be causing the exponential rise in depression that is occurring on a global scale. The World Health Organization describes depression as ‘the leading cause of disability’ in the world. The U.S. leads the way, with 13% of the population on anti-depressants.
If we look at the nature of modern diets and lifestyles, it seems obvious that they are a catalyst for the inflammatory process.
Here are the 6 most likely causes of gut damage, leading to leakiness and inflammation:
1. Certain pharmaceuticals. The biggest offenders are the non-steroidal anti-inflammatory drugs, or NSAIDs like asprin and ibuprofen. Tests have shown that around two thirds of NSAID users have a leaky gut.
I had a history of taking NSAIDs.
2. Stress and anxiety. Stress and anxiety cause leaky gut, and leaky gut can cause… stress and anxiety.
This was a chicken-and-egg situation for me: I don’t know which came first. I was really down about the state of my skin and digestion, and stressed by the frustration of not being able to do anything about it. Stress makes things worse by generating free radicals — harmful chemicals that contribute to intestinal permeability.
I wasn’t in the best of places.
3. Dysbiosis. This is the term used to describe an imbalance between the good and bad bacteria (and other microorganisms) that live in the gut.
The friendly bacteria play a critical role in maintaining barrier function, and keeping out the undesirables and their toxins. When the bad guys seize power, the good guys retreat, creating a state of dysbiosis and intestinal chaos.
Symptoms of dysbiosis can include bloating, gas, cramping, brain fog, depression, and many common intestinal maladies.
Well, I definitely had that, as it turned out.
4. Diet. The dietary factors most likely to increase the leakiness of your gut include: alcohol, sugar, refined carbohydrates and refined cooking oils. Vegetable oils made from corn, soya and sunflower are especially culpable. They are high in omega-6 fatty acids, which are notorious for their pro-inflammatory effects.
All of these were present in my diet at the time.
5. Smoking. It’s the habit that keeps on taking. It’s also free radical hell.
I smoked like a trooper in my late teens and throughout my 20s.
6. Allergens. Foods to which you are allergic or intolerant also create irritation and inflammation.
Finally, a box I didn’t tick!
How to Heal
“Observational studies have linked healthier diets with a lower risk for depression. Prospective studies suggest that healthier diets offer some protection against the development of both depressive symptoms and depressive disorders.”
The good news is that if you have a leaky gut, you can bypass all the years of my learning curve and go straight to the healing stage.
In my early, pre-student days, I lurched from one bad lead to another in my quest to resolve all these issues. I saw a succession of doctors and therapists who turned out to be as clueless as I was.
These included a skin specialist who gave me antibiotics, which only made things worse.
Then there was the homeopath (zero effect), the spiritual ‘healer’ (let’s not even go there) and the Chinese herbalist. The latter, I was convinced, was my man. Here was a sage from the East, practising esoteric knowledge seeped in ancient wisdom, no?
I brewed up the foulest-tasting concoctions, believing the pain would be worth the gain.
There was no gain. And the pain continued.
At the time, I was a nutrition philistine, and had no idea that all my problems were connected.
What truly shocks me, even now, is that none of the specialists I consulted did, either.
I came to realise — eventually — that all my symptoms began and ended in my gut.
The most important wisdom I acquired on my nutrition course is that when a health problem presents itself, you have to deal with the cause, not the symptom.
So, for the first step on my self-directed healing journey, I invested in two scientific diagnostic tools: a stool analysis and a urine test.
Getting the right diagnosis
The stool analysis — or more specifically, “comprehensive digestive stool analysis” — is a simple test, carried out at home. The laboratory that first devised the test is based in the U.S., but practitioners all round the world use it. Different countries have different regulations about who can order a kit, so if this is something that interests you, check with your healthcare provider.
For more information, visit the Genova Diagnostics CDSA page.
The stool analysis revealed that I had a severe case of dysbiosis. The bad guys (actually, they were downright evil) were in control, rampaging through their dark kingdom like some crazed, Middle-Earth despot.
The good guys were hiding out in some distant intestinal backwater, too few and feeble to do their job, which was to guard my health.
Still, I was on the right track: these results meant that there was a very good chance I had a leaky gut.
As it turned out, the urine test confirmed my suspicions once and for all.
Called an “Intestinal Permeability Assessment”, this urine test is carried out by lots of medical laboratories, including the one I used for my stool analysis.
It’s an ingeniously simple test that you do at home. You just drink a solution of different sized insoluble sugar molecules, collect your urine, and mail off a sample. If your gut lining is healthy, the large molecules should pass straight through you undigested. But if they turn up in your urine, it means your gut lining is porous.
Sure enough, the results confirmed that I had a very permeable gut.
Did the positive test results lead me to further dispair? Au contraire! I couldn’t have been happier. Because I knew exactly what to do next.
An Action Plan
Here’s what I did. If your own test results confirm a leaky gut, these actions can help you, too.
First, I started taking probiotics — supplements containing friendly bacteria to fight the unfriendly. Probiotics also strengthen tight junctions and produce anti-inflammatory chemicals.
Probiotics are shaping up to be the medicine of the future. Not only can they improve the health of the gut, they can also have remarkable effects on the mind. A study published in The British Journal of Nutrition described a clinical trial of 30 volunteers suffering with depression. They were given a daily probiotic supplement combining strains of Lactobacillus and Bifidobacterium bacteria, for 30 days.
At the end of the trial, they had ‘significantly’ reduced symptoms of psychological distress, including depression, anger-hostility, and anxiety.
How so? The research is still in its infancy, but we do know that bacteria in the gut communicate with the brain via the vagus nerve, which links the two and which acts as a sort of two-way superhighway along which messages are exchanged.
As well as taking probiotics, I made sweeping changes to my diet.
Eliminate sugar and refined carbohydrates
Sugar is the enemy of health in so many ways. Sugary foods and drinks trigger the release of large amounts of the hormone insulin, which itself is a trigger for inflammation. The more insulin, the more inflammation.
Refined carbohydrates are, essentially, sugars. White bread, rice, pasta, chips, crisps and other savory snacks are all broken down to glucose in the gut, before being absorbed into the blood and raising insulin levels.
Drastically reduce refined vegetable oils
This means checking labels obsessively.
Because inflammatory omega-6 vegetable oils are ubiquitous in ready-made meals and take-out, it might be easier to cook all your food from scratch — using extra virgin olive oil, butter or coconut oil.
Coconut oil and butter are predominantly saturated, and remain stable at high temperatures. So too is extra virgin olive oil, which is predominantly monounsaturated.
I put myself on self-imposed ban of alcohol. Alcohol is well-known depressant, gut irritant and contributor to leaky gut syndrome. So I stay clear (most of the time… I am human).
Increase vegetable intake
I added as many vegetables as I could manage—especially the brightly colored ones, including peppers, tomatoes, red onions and eggplants. I made sure that I also ate at least one portion each day of dark leafy greens, such as cabbage, broccoli and spinach.
All these vegetables are loaded with antioxidants that fight damaging free radicals, and plant chemicals that fight inflammation. They are also a source of ‘prebiotics’, nutrients that feed the friendly bacteria in your gut and encourage their growth and activity.
Include fermented foods in your diet
Foods such as live yogurt, kefir, sauerkraut, and pickled vegetables increase your levels of lactic acid bacteria such as Lactobacillus acidophilus. This helps restore the microbial balance that is off-kilter in those of us with dysbiosis.
Eat oily fish
Patients with depression have been found to have lower blood omega-3 fatty acids than non-depressed people.
The importance of omega-3 fats to brain health cannot be overstated: they are involved in brain development, mood and cognitive function from pre-birth to old age.
Salmon, trout, mackerel, herring, anchovies and sardines are rich in anti-inflammatory omega-3 oils, which work in opposition to the pro-inflammatory omega-6 oils found in processed foods.
As part of my regime, I ate lots of oily fish, and just for good measure took a daily fish oil supplement.
Review your medications
Determine if you are taking NSAIDs. If you are, discuss alternative medications with your physician.
If you know a certain food gives you trouble, avoid it.
If you are not sure, you might try avoiding foods containing gluten and see if it helps. Gluten has a long association with leaky gut. Gluten is found in wheat, barley and rye.
Don’t graze in between meals
Prolonged breaks between meals —a form of intermittent fasting — can lower markers of inflammation.
You don’t have to do anything drastic — just stop unnecessary grazing between meals, and only eat when you are hungry. Giving your digestive system a rest gives it time to heal.
Free At Last
It took several months for me to complete the healing process. It was worth the effort: all my symptoms vanished, and I felt on top of the world.
They didn’t all vanish at once. But they did start to improve almost immediately. First, my digestion calmed down. The pain subsided, along with the gas. That was when I knew that the years of elastic waistbands were coming to an end.
My skin took a little longer to heal, but I was encouraged. Spots became less vicious, and didn’t hang around for so long. Eventually, they stopped appearing.
Along the way, I noted other minor improvements: clearer thinking, better, more refreshing sleep.
I was on a one-way street, heading in the direction of healing one step at a time.
I went on to practice as a nutrition consultant for over 15 years, and saw many cases of leaky gut in that time. I find it takes most people at least two months to heal. It’s a journey, as well as a transformation.
I am always struck by how people are affected in such different ways. Sometimes, leaky gut is fiendishly hard to spot. Although the vast majority of people with the condition also have digestive symptoms, some don’t.
I remember one particular man who had a nasty case of arthritis, all over his body, but no irritable bowel. He tested positive for leaky gut. The main clue was, and remains, inflammation — a signficant factor in depression, as we now know.
“When the two conditions co-occur, treating inflammation in tandem with depression can enhance recover and reduce the risk of recurrence.”
Leaky gut is a condition that can affect any one of us, and in so many ways—including, profoundly, our mental health.
And, as I discovered, there is nothing more empowering than acknowledging that you have the ability, through dietary changes, to turn around both your physical and your mental health.
It’s possibly the best journey you could go on.