As more understanding about the critical role of the gut microbiome in human health becomes available, its connection to many systems in the body continues to emerge. Many people don’t realize that the health of the gut microbiome may play a significant role in depression, including major depressive disorder, and anxiety, including generalized anxiety disorder or social anxiety disorder.^1-3

Mental health is a major healthcare challenge worldwide, with estimates that 11% of all people will experience major depressive disorder at some point in their lives.^3,4 Major depressive disorder is a condition that doesn’t always respond well to treatment; up to 30% of patients do not respond to antidepressants, indicating a need for different types of interventions that healthcare providers can offer.⁴ There appears to be a dietary connection to mental health. Studies have found two to four times higher levels of anxiety and depression in people with inflammatory bowel disease (IBD), causing research interest in dysbiosis in the human gut microbiome and its role in mental health, including the interplay between inflammation, gut health, and the burden of managing a chronic disease. Researchers Moulton et al. in a review piece about neuro-immune reactions and IBD, explain that though depressive symptoms could arguably be linked to the burden and pain associated with the condition, there is evidence of what they refer to as ‘inflammatory depression’ where the gut-brain axis, inflammation, and gut microbiome disturbances create the pathogenesis of depressive symptoms in this population.⁵  The connection between gut microbial imbalance and the pathogenesis of mental health problems suggests a connection between these systems, known as the gut-brain axis.^2,3,6

This gut-brain axis is a bidirectional communication system where the central nervous system, the enteric nervous system (residing in the gut), and the digestive tract interact and influence each other.⁷ Emerging evidence points to the gut microbiome affecting brain function and behavior through pathways that include immune modulation, neurotransmitter and hormone activity, and the stress response system.^2,4,7 A better understanding of these interactions could offer focus areas for healthcare providers to advise microbiome-supporting dietary changes that support mental health.

The Gut-Brain Axis and Mood
A key component of the gut-brain axis depends on the role of gut microbiota in producing neurotransmitters and other signaling molecules. Researchers have identified thirteen microbial taxa (a classification of the microorganisms) that are likely associated with depressive symptoms in a large cohort from the Rotterdam Study.⁸ The identified microbes are specifically involved in the production of neurotransmitters like glutamate, butyrate, serotonin, and gamma-aminobutyric acid (GABA), which play a role in the pathology of depression when imbalances occur.⁸Dopamine pathways, important for cognition, pleasure, and motivation among other mood-related functions, have a connection to the gut-brain axis with emerging research about specific genres of microbiota that play a role in both dopamine synthesis and breakdown.⁹ Researchers have also found that gut microbiome diversity was inversely associated with depressive symptoms, indicating that educating clients on ways to increase microbial diversity through dietary strategies is a place that healthcare providers could focus. For many people struggling with mood disorders, exploring strategies in addition to traditional medications can be empowering and offer hope.⁸ 

A study by Dong et al compared three groups: people with major depressive disorder (n=23), people with generalized anxiety disorder (n=21), and healthy control subjects (n=10), and found significant differences in microbial richness and diversity, especially between the generalized anxiety disorder group and healthy controls.¹⁰ The differences between the generalized anxiety disorder group and the control group were significant in several ways. Researchers found that certain types of bacteria tested significantly decreased in quantity, as well as others that significantly increased in both the generalized anxiety disorder group compared to controls and the generalized anxiety disorder group compared to the major depressive disorder group. For example, there were differences in the abundance of specific genera of bacteria such as lower levels of Sutterella and Fusicatenibacter in people with major depressive disorder compared to controls and lower levels of Fusicatenibacter and Christensenellaceae_R7_group in generalized anxiety disorder than in the controls.¹⁰ These researchers indicate that as more is learned about specific types and quantities of bacteria concerning conditions like major depressive disorder and generalized anxiety disorder, more targeted interventions and therapies could emerge.¹⁰

Another study by Butler et al explored the gut microbiome’s role in social anxiety disorder by comparing the microbiome compositions of individuals with social anxiety disorder (n=32) to healthy controls (n=32). They discovered that the overall microbiome composition in addition to several specific bacterial taxa, significantly differed between the two groups.¹¹ Of the 73 genres and 159 species identified, three genera and two species showed significant differences in abundance. For example, Anaeromassilibacillus and Gordonibacter were found at higher levels in participants with social anxiety disorder and Parasutterella was more abundant in control participants. This study is one of the first to demonstrate that the gut microbiome of people with social anxiety disorder is compositionally different from healthy controls and helps identify the specific bacterial genre. They advise more clinical studies to explore the mechanistic pathways behind this observance and larger, longitudinal studies on people with social anxiety disorder with the hopes of opening more treatment options for these patients in the future.¹¹ 

Study findings generally suggest that the gut microbiome may influence the development or exacerbation of mental health disorders, potentially offering new therapeutic targets through dietary or lifestyle interventions. A holistic approach that helps treat the underlying cause of depression and anxiety could provide a supportive strategy that healthcare providers can offer in addition to traditional therapies. There is a need for more studies that help determine which types of bacteria or shifts in microbiome diversity may be beneficial or problematic for people with depression and/or anxiety. 

Impact of Diet on the Gut Microbiome

Dietary Patterns
Studies have consistently shown that diets with higher intakes of vegetables, fruits, cereals, nuts, seeds, and pulses (legumes like beans or lentils) commonly found in dietary patterns like Mediterranean, Japanese, and Norwegian diets are associated with a lower incidence of depression.⁶ Conversely, the “Western”/Standard American dietary pattern, high in added sugars, refined grains, fried and ultra-processed foods, and red or processed meat, with low fruit and vegetable intake, is frequently associated with a higher incidence of depression.⁶

Micronutrients and Polyphenols

Certain micronutrients, including zinc, magnesium, selenium, iron, and vitamins B-6, B-12, D, E, and folate, are often found at low levels in people with depression.⁶ These deficiencies might negatively affect neurotransmitter production such as serotonin, brain signaling, and pathways involving inflammatory and oxidative stress.⁶ Diets rich in fruits and vegetables not only provide higher levels of these micronutrients but also contain potent antioxidant phytochemicals like vitamin C, polyphenols, and flavonoids, which studies show may offer antidepressant-like effects as well as anti-inflammatory activity.^12,13 Researchers have linked these compounds mechanistically to reduced depression through several regulating factors such as anti-inflammatory and reduced oxidative stress effects (including the ability to reduce neuroinflammation), and gut microbiome modulation through affecting the intestinal barrier function, influencing signaling pathways, and modifying the composition of gut microbes.^12,13

Dietary Fat 

Fatty acids, particularly polyunsaturated fatty acids (PUFAs) like omega-3 fats eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) are essential for neural function and are incorporated into neural tissue. They are found in seafood including fish and shellfish, and microalgae, and also come in dietary supplement form. Studies on omega-3 fatty acids have shown that they may play a significant role in alleviating symptoms of depression in both dietary and supplemental forms. An observational study by Mehdi et al. following 165 patients with major depressive disorder found that supplementing with 500mg of omega-3s daily, particularly in combination with traditional antidepressants, resulted in a significant reduction in depressive symptoms compared to either treatment (omegas or medication) alone.¹⁴ Combination therapy improved depressive symptoms more effectively, highlighting the potential benefits of integrating omega-3 fatty acids via diet or supplementation for people with depression.

Prebiotics, Probiotics, and Synbiotics
Interventions including probiotics, prebiotics, and synbiotics (a combination of probiotics and prebiotics) could also play a role in reducing depressive symptoms in some patients. A large systematic review (n=43 studies) by Alli et al., found notable differences in the gut microbiome profiles between individuals with major depressive disorder and healthy controls, particularly regarding diversity and specific microbial taxa.⁴ The researchers observed that families Bifidobacteriaceae and Streptococcaceae, and Eggerthella and Streptococcus genera were increased in patients with major depressive disorder while the phylum Bacteroidetes, family Sutterellaceae, genus Coprococcus, and genus Faecalibacterium were decreased. The review highlighted that interventions with probiotics and synbiotics might offer modest benefits per validated rating scale scores in reducing depressive symptoms. Interestingly, prebiotics alone did not show a significant effect on depressive symptoms in this study.⁴ 

Takeaways for Providers 

As research continues to develop about the link between gut microbiome diversity and mental health disorders such as anxiety and depression, new avenues are opened for healthcare providers to integrate gut health considerations into mental health treatment plans, depending on their scope of practice. Given the emerging evidence, practitioners should consider gut health as a potentially contributing component of mental health. By incorporating strategies aimed at modulating the gut microbiome through dietary pattern adjustments – incorporating more vegetables, fruits, cereals, nuts, seeds, and beans/lentils – ensuring adequate micronutrient and polyphenol intake, or even considering probiotic and omega-3 fatty acid supplementation, healthcare providers can offer dietary options that may help to address both the psychological (social anxiety disorderness, irritability, apathy, or loss of interest in activities) and physiological aspects (fatigue, sleep disturbances, weight changes, changes in appetite) of mood disorders.¹⁵ An integrated approach not only aligns with growing scientific understanding but also enhances the scope of potential therapeutic interventions, helping to improve patient mental health outcomes.

References:

1. Limbana T, Khan F, Eskander N. Gut microbiome and depression: how microbes affect the way we think. Cureus. 2020;12(8).
2. Liu L, Wang H, Zhang H, et al. Toward a deeper understanding of gut microbiome in depression: the promise of clinical applicability. Advanced Science. 2022;9(35):2203707.
3. Medina-Rodriguez EM, Cruz AA, De Abreu JC, Beurel E. Stress, inflammation, microbiome and depression. Pharmacology Biochemistry and Behavior. 2023:173561.
4. Alli SR, Gorbovskaya I, Liu JC, Kolla NJ, Brown L, Müller DJ. The gut microbiome in depression and potential benefit of prebiotics, probiotics and synbiotics: a systematic review of clinical trials and observational studies. International journal of molecular sciences. 2022;23(9):4494.
5. Moulton CD, Pavlidis P, Norton C, Norton S, Pariante C, Hayee B, Powell N. Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation?. Clinical & Experimental Immunology. 2019;197(3):308-18.
6. Bear TL, Dalziel JE, Coad J, Roy NC, Butts CA, Gopal PK. The role of the gut microbiota in dietary interventions for depression and anxiety. Advances in Nutrition. 2020;11(4):890-907.
7. Chakrabarti A, Geurts L, Hoyles L, et al. The microbiota–gut–brain axis: pathways to better brain health. Perspectives on what we know, what we need to investigate and how to put knowledge into practice. Cellular and Molecular Life Sciences. 2022;79(2):80.
8. Radjabzadeh D, Bosch JA, Uitterlinden AG, et al. Gut microbiome-wide association study of depressive symptoms. Nature communications. 2022;13(1):7128.
9. Hamamah S, Aghazarian A, Nazaryan A, Hajnal A, Covasa M. Role of Microbiota-Gut-Brain Axis in Regulating Dopaminergic Signaling. Biomedicines. 2022 Feb 13;10(2):436.
10. Dong Z, Shen X, Hao Y, et al. Gut microbiome: a potential indicator for differential diagnosis of major depressive disorder and general anxiety disorder. Frontiers in Psychiatry. 2021;12:651536.
11. Butler MI, Bastiaanssen TF, Long-Smith C, et al. The gut microbiome in social anxiety disorder: evidence of altered composition and function. Translational psychiatry. 2023;13(1):95.
12. Winiarska-Mieczan A, Kwiecień M, Jachimowicz-Rogowska K, Donaldson J, Tomaszewska E, Baranowska-Wójcik E. Anti-Inflammatory, Antioxidant, and Neuroprotective Effects of Polyphenols—Polyphenols as an Element of Diet Therapy in Depressive Disorders. International Journal of Molecular Sciences. 2023;24(3):2258.
13. Ali S, Corbi G, Maes M, Scapagnini G, Davinelli S. Exploring the impact of flavonoids on symptoms of depression: A systematic review and meta-analysis. Antioxidants. 2021;10(11):1644.
14. Mehdi S, Manohar K, Shariff A, et alOmega-3 fatty acids supplementation in the treatment of depression: An observational study. Journal of Personalized Medicine. 2023;13(2):224.
15. Remes O, Mendes JF, Templeton P. Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature. Brain Sci. 2021;11(12):1633.

This month, we’re thrilled to recognize Dr. Aileen Litwin, one of our valued Orgain Healthcare Advisory Panelists. Dr. Litwin has been an active Orgain Healthcare Ambassador and now sits on our Healthcare Advisory Panel where she provides consulting support, insights and expertise to the Orgain Healthcare team. Thank you for all that you do, Dr. Litwin!

About Dr. Aileen Litwin

Dr. Litwin is a triple board-certified (General Pediatrics, Lifestyle Medicine, Obesity Medicine) pediatrician and the founder of Happy Healthy Pediatrics, a private practice committed to supporting families through evidence-based, holistic medical care with a focus on foundational wellness, balanced family dynamics, and resilience. 

Learn more about Dr. Litwin’s background and how she uses Orgain with patients, in our exclusive interview below.

Orgain X Dr. Aileen Litwin – Interview

1. Please tell us a little bit about yourself personally and professionally so that our readers will be able to “get to know you.”
   I’m a pediatrician and mom to 3 boys (with one on the way!). I opened my solo practice after deciding I needed to create a space where there was time to get to know my patients and their families and provide personalized health and wellness recommendations. I have board certifications in general pediatrics, obesity, and lifestyle medicine. I truly believe that we can create a better society by raising healthy, resilient, and kind children. 
   
2. How do you use Orgain in your practice? 
   Orgain allows me to give families opportunities to work in nutritious, delicious options for meals and snacks in a convenient way. Most families are on the go and the busyness of life can be a barrier to eating well. Orgain offers protein powders, shakes, supplements, and bars that make choosing the healthier option so much easier! I frequently recommend Orgain products for on-the-go meal, snack, and workout/recovery options for my families!
    
3. What inspired you to become a pediatrician?
   I’ve always admired children for their determination to get on with life (watch any infant or toddler learning to walk and tripping over and over again and always getting up), to be fascinated with exactly what’s happening right in front of them (the original masters of mindfulness), and their natural tendency to love and trust unconditionally. When I learned that there was a job where I could learn how to help children when they become ill or just learn enough to help them be healthy and happy- I was sold!

We’re excited to showcase our newest ready-to-drink product: Orgain 30g Protein Shake! 

This shake is crafted with 30g of ultra-filtered premium protein using milk protein isolate and contains 6g of naturally occurring BCAAs to help stimulate muscle protein synthesis and support muscle recovery.* Not to mention, Orgain 30g Protein Shakes contain only 1g of sugar and no artificial flavors or sweeteners. These shakes are available in a delicious, creamy chocolate fudge flavor and are conveniently packaged in single serve resealable packaging making them a great option for on-the-go nutrition. 

The Orgain 30g Protein Shake is currently available on Orgain.com, Costco and Amazon with anticipated expansion into additional retailers later this this year. For those of you who are Orgain healthcare ambassadors, our 30g Protein Shake is not presently included in our sampling program, however we will be evaluating it as an option as it continues to grow in popularity.

If you’re not yet an Orgain Healthcare ambassador, we would love to have you join us! To be eligible, you must be a credentialed healthcare professional providing direct patient care at a healthcare practice or facility. To learn more about the program and benefits, visit HERE.

*Results may vary when used in conjunction with an intense daily exercise and adequate caloric balance.

New Episode: Protein Deep Dive for Fitness, Motherhood and Beyond with Kelly Jones MS, RD, CSSD, LDN
In this episode, Host Ginger Hultin discusses the importance of protein intake with Kelly Jones, a fellow registered dietitian and sports nutrition specialist. They debunk myths around protein requirements, highlight discrepancies in media reports, and emphasize the significance of individualized protein intake needs. The conversation delves into protein requirements for athletes, pregnant and postpartum women, and everyday active individuals. 

Upcoming Episode: The Athlete’s Plate: Mastering Nutrition and Hydration with Kelly Jones with Kelly Jones MS, RD, CSSD, LDN
In episode 44, available on July 23^rd, Ginger Hultin builds on her conversation with Kelly Jones discussing the critical role of hydration and nutrition for athletes. They dive into many aspects of athlete’s health, including the importance of sodium and fluids for hydration, protein and calorie needs, and how to fuel for various sports. They also address the challenges of maintaining a balanced diet amidst a busy schedule, the impacts of disordered eating, and the physiological changes faced by young athletes. Kelly provides practical tips for parents, coaches, and athletes on optimizing diet and hydration strategies to enhance performance and overall health. 

Be sure to subscribe to The Good Clean Nutrition Podcast on your favorite podcast platform and listen to more episodes on a variety of platforms HERE. 

Register now for our upcoming Live webinar on July 18^th, 2024, at 2pm EST, Unlocking the Potential of GLP-1 RA: What we’ve learned and its implications in lifestyle by Angela Manderfeld, MS, RD, CDCES, BC-ADM

 
Don’t miss our upcoming webinar designed to empower you with essential knowledge and skills in the realm of GLP-1 Receptor Agonists (GLP1 RAs). Become adept at identifying clients who stand to benefit most, as well as possible downsides. Moreover, we will explore the vital nutrition and lifestyle implications for clients taking GLP1 RAs, providing you with the tools to optimize their well-being. Discover effective strategies to help your clients increase their endogenous GLP1 production without the need for medications, ultimately enhancing their health and quality of life.

Tune in to last month’s on-demand webinar, released June 20^th, 2024, 2pm EST: Optimizing Hydration: Strategies for Healthy Adults of Varied Activity Levels by Kelly Jones, MS, RD, CSSD, LDN

The Orgain Healthcare Professional Education Webinar Series can also be accessed on the Orgain Healthcare App. Whether on-demand or live, all the webinars in this series are available for 1.0 CPEU for RDNs and NDTRs.   

 Learn More >  

Orgain is excited to announce its presence at the following upcoming in-person conference & symposium. If you plan to attend, be sure to stop by our booth and say hello as we’d love to meet you!    

 

Food & Nutrition Conference & Expo (FNCE)
October 5-8^th, Minneapolis, MN