A decade ago, soon after I moved to Africa, I got sick a lot. I had several bacterial and viral infections, and many small colds. I was tired all the time, mothering toddlers in a new environment, and working as a trauma therapist with clients facing enormous amounts of trauma and pain.
I got gradually sicker, experiencing muscle pain, nerve and joint pain, irritable bowel, and severe hormonal changes. I was bloated, unable to sleep well, fatigued, and moody. My doctor suggested that I see a psychiatrist and start taking antidepressants. I told him that I didn’t think this was depression. True, I was moody, but something wasn’t right in me physically. Although there was no way to know for sure, I felt strongly that treating only the emotional side of things was just not enough.
I come from a line of women who believed and practice mind-body healing. When I was sick as a child, my mother, like her mother, used all kinds of homemade remedies. When I was not well she was as likely to take me to a homeopathist or acupuncturist as to a medical doctor.
Now, less than confident in the advice I was getting, I found a Chinese doctor in South Africa, three hours from where I lived in Lesotho, and began seeing him monthly. He told me, “It is like your body is in a constant chronic flu state.” From a Chinese medicine perspective, he said, my body was fighting “heat.” Indeed, I felt like I was in an ongoing state of flu or infection of some kind. But from what?
Determined to heal, I began a long expedition of research, trial, and error that continues to this day. One benefit has been valuable learning for my role as a trauma therapist incorporating wellness and integrative health into my work. In the beginning, I mostly focused on nutrition and the brain-gut connection and continued to other avenues of integrative health.
My learning has led me to adopt what I call an “all-wellness” approach to dealing with complex injuries such as trauma. To me this means that sustainable responses to trauma have to address all aspects of well-being—emotional, cognitive, physical, spiritual and social. (See more here.)
In this post, I would like to introduce you to one of the most important aspects of well-being that I now realize must be addressed in treatment of trauma, and indeed in dealing with any mental health symptoms: inflammation.
The Gut-Brain-Axis (GBA)
The GBA is the communication system between your digestive system and nervous system, which are connected via your vagus nerve. The longest nerve in the body, the vagus (which means wandering) forks into two, one to the left and one to the right side of the body. Among other things, the vagus provides two-way communication between the brain and the gut.
The gut interacts with and influences so many activities in our body and brain that – already 20 years ago – one scholar began calling it “the second brain” (Gershon, 1998). According to Gershon, our gut and its environment play an important role in how we feel. When the gut is not functioning well, communication between the gut and the brain in our head suffers. Our physical and emotional health suffer as a result.
Rather than the simple understanding of the gut that you and I grew up with as a place where food is digested, researchers today recognize it to be a microbiome, a vast, interacting community of living microorganisms (such as bacteria, fungi, and viruses). These microbes outnumber our human cells, ten to one, and the majority live in the gut.
When there is an imbalance in the gut microbiome, other organs are affected, including our brain. Imbalance in the gut could play a key role in symptoms such as pain, stress, and sensory processing that can manifest as chronic fatigue, brain fog, low and high blood pressure, insomnia, hormonal imbalance, mental health symptoms and many more.
What Causes Gut Imbalance
Many variables affect gut imbalance. The key ones are:
- Stress. The more we are exposed to stress the greater its impact on our gut.
- Diet. High-sugar, high-fat, processed foods impact gut inhabitants differently, and overgrowth of some results.
- Environment toxins, which accumulate and burden the gut.
- Infections (from viruses, bacteria) and overgrowth of fungi, mold, and pathogens also lead to overgrowth.
- What we eat affects how we feel.
- Stress affects the gut which in turn affects how we feel.
- What is happening in the gut affects our response to stress.
The mechanisms for these effects are complex and much remains to be learned. Werbner et al (2019) suggested that stress causes changes in the activity of the gut. These changes trigger immune responses from the body that can include an inflammation “attack” of the body against itself. Whatever the mechanism, it is well-established that gut dysbiosis contributes to inflammation. In other words, an overgrowth of bad bacteria or pathogens in the gut triggers inflammation in the body.
What Is inflammation?
Inflammation is a defense mechanism triggered in the body when it recognizes an attack and gathers special resources in response. It’s a requirement for survival. For example, the red soreness that appears around an infected wound is an inflammatory response essential to isolating invaders and ensuring their destruction before they spread. The body responds with inflammation to a wide variety of threats, including not only infections, but also irritants, stress and physical trauma.
When we are exposed to any of these triggers, the body produces small protein cells called cytokines. These small cells facilitate the response of the body to threat. Their presence can be measured and used to assess inflammation levels in the body. (Chang et al., 2010).
There is growing evidence on many fronts that inflammation affects how we feel. This influence is exerted through many systems, including the immune system, metabolism, sleep, stress responses, cognitive thinking, memory, expression, impulse control, mood, clarity, and more. Much remains to be learned about the mechanisms and effects of inflammation, but the existence of a linkage between inflammation and these many systems, each a key element of emotional functioning, is now indisputable.
This means that as professionals committed to working competently with our clients we need to begin paying attention to inflammation.
There’s a lot of research on inflammation now underway. Here are a few areas of research that I find particularly interesting for people with mental health symptoms and their clinicians:
Depression, Bipolar, Anxiety, and Inflammation
More and more studies suggest that depression and/or bipolar disorder are accompanied by immune system dysregulation and inflammation, and high levels of cytokines. Inflammation has been found to trigger depression, almost like an allergic reaction. This study suggests that an immunotherapy perspective has potential in the treatment of depression.
ACE, Stress, PTSD and Inflammation
Exposure to childhood adversity has been linked to the development of inflammatory conditions later in life. Stress at a young age is associated with gut inflammation that can lead to problematic mental and physical conditions.
The mechanism seems to be that stress hormones affect the organisms living in the gut and their balance with each other. Gut imbalance can lead to damage in the lining of the gut (known as “leaky gut”). As a result toxins and bacteria “leak" through the intestines and enter the bloodstream. This triggers a reaction of the immune system: inflammation.
Eventually inflammation spreads to other organs including the brain and contributes to increased vulnerability to the emergence of a variety of symptoms we refer to as sensory processing disorder, ASD, ADHD, ODD, BPD, bipolar, depression, anxiety, auto-immune conditions (arthritis, irritable bowel disease, Lupus, MS), Chronic Fatigue Syndrome, Fibromyalgia, PTSD, CPTSD, and others.
Adverse childhood experiences also affect the microbiome. Callaghan et al. (2019) found that "children with a history of early caregiving disruptions had distinctly different gut microbiomes from those raised with biological caregivers from birth. Brain scans of all the children also showed that brain activity patterns were correlated with certain bacteria. For example, the children raised by parents had increased gut microbiome diversity, which is linked to the prefrontal cortex, a region of the brain known to help regulate emotions.”
In another study, Renna et al. (2018) found that people with a diagnosis of PTSD, OCD, or anxiety disorder had significantly higher levels of inflammatory markers in comparison to people without such a diagnosis.
An in-depth South African study compared the gut microbiome of trauma survivors who developed PTSD with the microbiome of those who did not develop PTSD. The participants who developed PTSD had significantly lower levels of three bacteria — Actinobacteria, Lentisphaerae and Verrucomicrobia. Participants who experienced childhood trauma also had significantly lower levels of these three bacteria. The findings also indicate that childhood trauma survivors are more at risk to develop PTSD later in life. (Hemmings et al. 2017) The authors suggested that these changes in gut microbiome happened early in life in response to adverse experiences. They theorized that the low levels of these three bacteria may have resulted in dysregulation of the immune system and high markers of inflammation in trauma survivors who had PTSD. Levels of inflammatory markers measured in individuals shortly after a traumatic event were shown to predict later development of PTSD. In other words, high inflammation markers in trauma survivors right after trauma can indicate the likelihood of the development of PTSD.
In my view, this research raises the question of egg or chicken: Does stress cause inflammation or does inflammation cause stress responses? It’s likely to be both. The more we are exposed to stress, the more likely that inflammation will be triggered. The more we have inflammation in our body, the more easily we are overwhelmed by stress.
Flory and Yehuda (2018) proposed that if inflammation markers are an extension of trauma-related outcomes and lead to medical illnesses, then PTSD should properly be understood as a systemic illness linked to psychological trauma. PTSD therefore requires a comprehensive approach to the biomedical consequences of trauma. Interventions should include things like physical activity, acupuncture, meditation, yoga, anti-inflammatory diet, which may mitigate PTSD symptoms by reducing inflammation.
Causes of Inflammation
Many variables can trigger inflammation and initiate mental and physical symptoms:
- Short and long term exposure to stress.
- High sugar, high processed starch/carb diet.
- Processed fats (processed oils, fried food).
- Food sensitivities/allergies.
- Viral/bacterial infections, pathogens etc.
- Autoimmune conditions.
- Environmental toxins.
- Malnutrition (diet low in micro and macro nutrients).
In my clinic I see trauma survivors suffering from chronic mental health symptoms improve — some only modestly but many significantly — when we began addressing inflammation and root causes of inflammation. Study of the literature referenced in this post, together with my own experiences as a trauma survivor and therapist have brought me to the conclusion that an all-wellness approach ought to be mainstreamed to everyone suffering from mental health symptoms.
What to Do About Inflammation
Serious problems made up of many inter-related elements require a long-term perspective in treatment. Like many other things, we need to target inflammation in the context of a sustainability plan:
1. Become informed.
Whether you are a trauma survivor, parent, teacher or clinician, an essential first step is to read as much as you can. The links in this post are a good start.
2. Nurture your body.
- Avoid sugars and significantly reduce processed foods.
- Eat whole foods as much as possible, especially vegetables.
- Avoid eating already made boxed foods.
- Consider one of these diets: keto anti-inflammatory, autoimmune protocol, anti-inflammatory diet.
- Ask your doctor to check for inflammation and genetic markers, and viral/bacterial infections. You may need to find an integrative practitioner to help you with that.
- Eat organic or grass-fed proteins as much as possible.
- Avoid fruit and seed-based oils; use avocado oil and olive oil instead
- Increase your cardio exercise (cardio).
- Check for food sensitivities/allergies.
- Consider supplements, consult a professional.
3. Body-mind connection.
- Increase your Vagal Tone through breathing, mindful movement, singing, etc.
- Sleep for 8 hours and try to go to sleep by 11 p.m.
- Spend time outdoors.
4. Enhance your spontaneity, playfulness, and creativity.
- Try to engage in any form of art-making.
- Find ways to socially engage with others, volunteer or join a service group, take a course, connect to a hobby or interest group, join a faith community, etc.
- Get a pet.
- Journal. Clarity about what gives us meaning in life facilitates calmness. Journaling about what used to be meaningful to you, and about what brings you meaning now will help you clarify your sources of meaning.
- Review your expectations for your life. Realistic expectations about how you will experience life make it easier to deal with stressful times. Write out your definitions of "happy," "loved," "sad," etc. These are words people use in describing their experience of life, but often without really defining what they mean.
- Investigate joy. What used to bring joy? What brings joy now? How do you feel when you are joyful?
Remember that YOU are the only authority on your body. If someone or something like medication or food makes you feel bad or worse, and your medical professional does not support you, find one who does.
Berk, M., Kapczinski, F., Andreazza, A. C., Dean, O. M., Giorlando, F., Maes, M., ... & Magalhães, P. V. S. (2011). Pathways underlying neuroprogression in bipolar disorder: focus on inflammation, oxidative stress and neurotrophic factors. Neuroscience & biobehavioral reviews, 35(3), 804-817.
Callaghan, B. L., Fields, A., Gee, D. G., Gabard-Durnam, L., Caldera, C., Humphreys, K. L., ... & Tottenham, N. (2019). Mind and gut: Associations between mood and gastrointestinal distress in children exposed to adversity. Development and psychopathology, 1-20.
Chang, T. T., Yen, Y-C., (2010). Cytokines and Major Psychiatric Disorders. Taiwanese Journal of Psychiatry (Taipei) Vol. 24 No. 4, 257-268.
Dobbin, J. P., Harth, M., McCain, G. A., Martin, R. A., & Cousin, K. (1991). Cytokine production and lymphocyte transformation during stress. Brain, behavior, and immunity, 5(4), 339-348.
Gershon, M. D. (1999). The enteric nervous system: a second brain. Hospital Practice, 34(7), 31-52
Haroon, E., Raison, C. L., & Miller, A. H. (2012). Psychoneuroimmunology meets neuropsychopharmacology: translational implications of the impact of inflammation on behavior. Neuropsychopharmacology, 37(1), 137.
Hemmings, S. M., Malan-Muller, S., van den Heuvel, L. L., Demmitt, B. A., Stanislawski, M. A., Smith, D. G., ... & Marotz, C. A. (2017). The microbiome in posttraumatic stress disorder and trauma-exposed controls: an exploratory study. Psychosomatic medicine, 79(8), 936.
Foster, J. A., Rinaman, L., & Cryan, J. F. (2017). Stress & the gut-brain axis: regulation by the microbiome. Neurobiology of stress, 7, 124-136.
Martin, C. R., Osadchiy, V., Kalani, A., & Mayer, E. A. (2018). The Brain-Gut-Microbiome Axis. Cellular and Molecular Gastroenterology and Hepatology, 6(2), 133-148.
Michopoulos, V., Powers, A., Gillespie, C. F., Ressler, K. J., & Jovanovic, T. (2017). Inflammation in fear-and anxiety-based disorders: PTSD, GAD, and beyond. Neuropsychopharmacology, 42(1), 254.
Milaniak, I., & Jaffee, S. R. (2019). Childhood socioeconomic status and inflammation: A systematic review and meta-analysis. Brain, behavior, and immunity.
Renna, M. E., O'toole, M. S., Spaeth, P. E., Lekander, M., & Mennin, D. S. (2018). The association between anxiety, traumatic stress, and obsessive–compulsive disorders and chronic inflammation: A systematic review and meta‐analysis. Depression and anxiety, 35(11), 1081-1094.
Smith S. R. (1997). Immunological Evidence Supporting The Immune-Cytokine Model of Depression. Cytokines and Depression.
Sylvia, K. E., & Demas, G. E. (2018). A gut feeling: microbiome-brain-immune interactions modulate social and affective behaviors. Hormones and behavior, 99, 41-49.
Toft, H., Bramness, J. G., Lien, L., Abebe, D. S., Wampold, B. E., Tilden, T., ... & Neupane, S. P. (2018). PTsD patients show increasing cytokine levels during treatment despite reduced psychological distress. Neuropsychiatric disease and treatment, 14, 2367.
Werbner, M., Barsheshet, Y., Werbner, N., Zigdon, M., Averbuch, I., Ziv, O., ... & Koren, O. (2019). Social-Stress-Responsive Microbiota Induces Stimulation of Self-Reactive Effector T Helper Cells. mSystems, 4(4), e00292-18.