In the IBDCoach program, our philosophy emphasizes how the environment and the interconnection of differently bodily organs influences the disease course in IBD. One such connection deeply affected by the enviroment is the Microbiota-Gut-Brain Axis. In fact, the IBDCoach program is strategically designed to address the complexity and connection observed in the MGBA. The following post outlines the current scientific understanding and why the MGBA is highly significant in IBD.
What is the Microbiota-Gut-Brain Axis?
By now you’ve probably heard us at IBDCoach explore the diverse ecosystem of microorganisms (bacteria, viruses, and fungi) that inhabit our gut, referred to as the human microbiota. Not only do these organisms impact our gut health, but emerging evidence indicates they also greatly influence our brain, and thus our state of mind. Dysbiosis, an alteration of the composition and function of the gut microbiota, is increasingly identified in people with IBD. Interestingly, dysbiosis has been increasingly associated with neuropsychiatric disorders. Numerous studies have demonstrated the critical role mental health and psychological stress play in the disease progression of IBD, and now science is coming to understand, through the study of the microbiota-gut-brain axis (MGBA), why that is the case. The MGBA is the bidirectional communication between the GI tract, the microbes within it, and the central nervous system (CNS) involving crosstalk between the endocrine, immune and autonomic nervous system.
Brain-imaging studies of the gut-brain axis as far back as the 1980s demonstrate a direct connection between gut disturbances and resulting brain stimulus, such as areas in the brain that become activated due to gut distention (i.e. increased abdominal girth often from excess intestinal gas or fluid.) These effects were more pronounced in those with GI diseases.  We now know that signals from the gut can reach different parts of the brain including the limbic system, the prefrontal cortex, the amygdala, the hippocampus, and the cingulate cortex, all of which could influence our self-awareness, morality, fear, memory, and motivation. More recently, the focus has been on how the microorganisms in our gastrointestinal (GI) tract influence our brain.
What is the Microbiota-Gut-Brain Axis?
Our gut microbiota and brain are remarkable connected systems in our body that have been shown to be plastic entities that we have the ability to change. Considering both of these access points have great implications on one another and disease, understanding the MGBA’s functions may be powerful for patients looking to take better control of their IBD.
Our microbiota, which can be described as our microbial “organ,” serves various roles including regulating our immunity, protecting us against pathogenic infection, harvesting energy from our food, and maintaining our intestinal barrier’s integrity. We are exposed to microorganisms from birth and continue to be colonized by more and more diverse microbes throughout the first few years of life. By age 3-5, our microbiota more closely resemble the population that will persist through our adult lives. Recent studies have investigated how these trillions of bacteria can modulate our behavior. The impact of these microbes on our development can be observed in mice that are “germ-free” meaning they have no microbiome: their brains have significant deviations from normal mice not only in terms of brain volume and myelination (insulation of neurons), but also in behaviors related to anxiety, memory, sociability, and depressiveness.[4,5]
Additionally dysbiosis has also been correlated with alterations in mood and behavior. Both animal and human studies have demonstrated that depressed individuals present a microbial imbalance hallmarked by a reduction in microbial richness and diversity.6,7 In contrast, a diet that increases microbiota diversity is associated with improved cognitive ability.8 It is clear that our microbiota not only plays an essential role in gut health but also in brain physiology and subsequent behavior. This microbial organ is known to be malleable, influenced by diet, stress, genetics, antibiotics, exercise, disease and the environment. Knowing dysbiosis is often found in IBD patients, is it possible to change this ecosystem, and its effects on the brain to profoundly change the lives of IBD patients?
Our brain, the other incredible organ involved in the MGBA, has over 80 billion neurons that are constantly communicating with each other through electrical signals and chemical messengers called neurotransmitters. For centuries the brain was considered fixed or “hard wired.” Thanks to recent advances in neuroscience and the study of neuroplasticity, we now understand the brain’s ability to change and adapt as a result of our internal and external environment. By means of the MGBA, both physical and psychological stress has been linked to an increase in intestinal permeability.9 Studies confirm that psychological stress increases symptom prevalence and exacerbation in IBD by disturbing the microbiota and triggering an immune system response. [10,11] In fact, patients with IBD tend to have higher rates of psychological disturbances compared to other chronic diseases.
Considering intestinal permeability and an overt immune response are the hallmarks of IBD, it makes sense that managing stress levels certainly affects the course of the disease. Everyday our clients engage in practices such as meditation, exercise and getting better sleep which allow them to see an improvement in their IBD symptoms. This leaves us with the other half of the question: is it possible to change our brain to better serve our gut? And how does the brain influence IBD through the MGBA?
Pathways of Communication of the MGBA in IBD
While we continue to develop our understanding of the exact role of the MGBA in IBD, it is clear that there is a strong relationship between our gastrointestinal tract, the superorganisms within it, and our brain and behavior. Early evidence even suggests that alterations to the gut microbiota by means of prebiotics and/or probiotics may attenuate neuropsychiatric symptoms.[13–15]
At times this relationship between the GI tract and brain function can seem like the “chicken or the egg” paradox; poor mental health and IBD symptoms are often described as a vicious cycle as each seems to impact the other. Managing the frustrations that come along with living with IBD can seem daunting at times but addressing one’s most urgent needs, whether it be mental health or a flare, can be extremely helpful in improving the course of disease. Thus ignoring your mental health, diet, or anti- inflammatory interventions (such as medications and supplements) can be detrimental given this connection between the gut and the brain. This is why with IBD a multidimensional approach aligns with our biology and is needed to attain lasting states of remission.
Having the ability to modify and potentially improve our microbiota function with each meal we eat along with our daily activities looks to be promising for overall health. Similarly, altering our mindset whether it’s through our diet, meditation or other physical or mental activities is now being supported by research to be critical in mitigating intestinal inflammation. In summary, MGBA research has shed light to the areas of our life in which we can adapt to drastically improve the disease course in IBD. Here at IBDCoach we want to help you find the resources necessary to nourish your microbiota and find peace during difficult times. We believe lifestyle interventions such as diet, meditation, prebiotics, exercise, sleep, etc. can biologically, through the MGBA, provide significant transformations in your quality of life.
- Nishida, A. et al. Gut microbiota in the pathogenesis of inflammatory bowel disease. Clin. J. Gastroenterol. 11, 1–10 (2018).
- Cryan, J. F. et al. The Microbiota-Gut-Brain Axis. Physiol. Rev. 99, 1877–2013 (2019).
- Thursby, E. & Juge, N. Introduction to the human gut microbiota. Biochem. J. 474, 1823–1836 (2017).
- Liu, W.-H. et al. Alteration of behavior and monoamine levels attributable to Lactobacillus plantarum PS128 in germ-free mice. Behav. Brain Res. 298, 202–209 (2016).
- Campos Alline C. et al. Absence of gut microbiota influences lipopolysaccharide-induced behavioral changes in mice. Behav. Brain Res. doi:http://dx.doi.org/doi:10.1016/j.bbr.2016.06.027.
- Kelly, J. R. et al. Transferring the blues: Depression-associated gut microbiota induces neurobehavioural changes in the rat. J. Psychiatr. Res. 82, 109–118 (2016).
- Zheng, P. et al. Gut microbiome remodeling induces depressive-like behaviors through a pathway mediated by the host’s metabolism. Mol. Psychiatry 21, 786–796 (2016).
- Li, W., Dowd, S. E., Scurlock, B., Acosta-Martinez, V. & Lyte, M. Memory and learning behavior in mice is temporally associated with diet-induced alterations in gut bacteria. Physiol. Behav. 96, 557–567 (2009).
- Kelly, J. R. et al. Breaking down the barriers: the gut microbiome, intestinal permeability and stress-related psychiatric disorders. Front. Cell. Neurosci. 9, (2015).
- Mawdsley, J. E. & Rampton, D. S. Psychological stress in IBD: new insights into pathogenic and therapeutic implications. Gut 54, 1481–1491 (2005).
- Gao, X. et al. Chronic stress promotes colitis by disturbing the gut microbiota and triggering immune system response. Proc. Natl. Acad. Sci. U. S. A. 115, E2960–E2969 (2018).
- Braniste, V. et al. The gut microbiota influences blood-brain barrier permeability in mice. Sci. Transl. Med. 6, 263ra158 (2014).
- Rao, A. V. et al. A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog. 1, 6 (2009).
- Pinto-Sanchez, M. I. et al. Probiotic Bifidobacterium longum NCC3001 Reduces Depression Scores and Alters Brain Activity: A Pilot Study in Patients With Irritable Bowel Syndrome. Gastroenterology 153, 448-459.e8 (2017).
- Chong, H. X. et al. Lactobacillus plantarum DR7 alleviates stress and anxiety in adults: a randomised, double-blind, placebo-controlled study. Benef. Microbes 10, 355–373 (2019).
- Mental Health—An invisible driver of IBD cost of care. Crohn’s & Colitis Foundation https://www.crohnscolitisfoundation.org/blog/mental-health-invisible-driver-ibd-cost-care.
- Enders, G. GUT. (Guila Enders, 2015).
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