Gut Feelings: Tweaking the Microbiome for Mental Health Treatment

Who would’ve thought part of your digestive system could impact your brain? Since that discovery was made, it’s been a trend in recent years to study the connection between the gut and the brain, called the gut-brain axis. As connections between the brain and mental function are continuously being made, there is the potential to employ the gut-brain axis in mental health therapies. But like with any emerging field in medicine, it raises several ethical considerations that need to be worked through.

The human gastrointestinal tract is inhabited by trillions of microorganisms that are collectively known as the gut microbiome. These microorganisms have been found to play a significant role in human function, specifically in brain activity and mental health, through several mechanisms including neurotransmitter production, immune system regulation, and direct communication within the vagus nerve (1). Given this discovery, we can look at mental health disorders through the gut health lens. Conditions like depression and anxiety are being considered from the perspective of the microbiome (2). As a result, there are new approaches to treating these disorders and reducing the burden on the individuals living with them.

One of the more accessible ways of influencing the microbiome is with probiotics, beneficial bacteria that are usually found in fermented products. Researchers have even coined the term “psychobiotics” to represent the probiotics that induce mental health benefits, such as the Bimuno-galacto-oligosaccharides (B-GOS) and Bacteroides fragilis. Psychobiotics work in three ways: psychological effects on emotional processes, systemic effects on glucocorticoid stress response, and effects on neurotransmitters and proteins (3). An initial comprehensive meta-analysis found that probiotic supplementation had a significant reduction in depressive symptoms (4). Another study even found that a specific combination of probiotics reduced anxiety and improved cognitive ability in patients with Alzheimer’s disease (5).

Ethical questions arise when considering whether patients fully understand that probiotics are experimental treatments, not cures. It’s also important to examine if probiotics should then be considered as pharmaceuticals if they’re part of treating medical conditions, addressing the need to regulate how companies advertise their probiotic products so they don’t overstate their benefits.

A much more extreme treatment option is fecal microbiota transplantation (FMT), a procedure consisting of transferring healthy fecal matter from a donor into a recipient to restore a healthy balance to their microbiome. A case study study showed an improvement in treatment-resistant depression in one patient after FMT, an interesting result for potential future studies. Specifically, there was an increase in Firmicutes and Lachnospiraceae counts and a decrease in Bacteroidetes counts, showing how the microbiome was rebuilt in this patient (6). When using FMT, though, one of the main ethical concerns is the screening process for the donor. Because it is part of the microbiome that is being transferred, the vast-reaching effects of the gut-brain axis play a role in determining a donor because there could be unwanted effects that arise from the donor’s biology. The microbiome is also being drastically changed for the recipient through an invasive process, which puts forth the question of how bad a mental health condition must be before FMT becomes an option. Would the recipient still have the same personality and autonomy after such an immense change?

As with any new avenue of scientific exploration, the ethics of using the microbiome need to be considered at every step. But, this field holds promise, and research should continue to be performed in order to find new avenues for treating mental health disorders. 

Graphic by Ariha Mehta

Reviewed by Sanjana Anand

References 

1. Cryan, J. F., O'Riordan, K. J., Cowan, C. S. M., Sandhu, K. V., Bastiaanssen, T. F. S., Boehme, M., ... & Dinan, T. G. (2019). The microbiota-gut-brain axis. Physiological Reviews, 99(4), 1877-2013.

2. Valles-Colomer, M., Falony, G., Darzi, Y., Tigchelaar, E. F., Wang, J., Tito, R. Y., ... & Raes, J. (2019). The neuroactive potential of the human gut microbiota in quality of life and depression. Nature Microbiology, 4(4), 623-632.

3. Sarkar, A., Lehto, S. M., Harty, S., Dinan, T. G., Cryan, J. F., & Burnet, P. W. (2016). Psychobiotics and the manipulation of bacteria–gut–brain signals. Trends in Neurosciences, 39(11), 763-781.

4. Ng, Q. X., Peters, C., Ho, C. Y. X., Lim, D. Y., & Yeo, W. S. (2018). A meta-analysis of the use of probiotics to alleviate depressive symptoms. Journal of Affective Disorders, 228, 13-19.

5. Akbari, E., Asemi, Z., Daneshvar Kakhaki, R., Bahmani, F., Kouchaki, E., Tamtaji, O. R., ... & Salami, M. (2016). Effect of probiotic supplementation on cognitive function and metabolic status in Alzheimer's disease: a randomized, double-blind and controlled trial. Frontiers in Aging Neuroscience, 8, 256.

6. Cai, T., Shi, X., Yuan, L. Z., Tang, D., & Wang, F. (2019). Fecal microbiota transplantation in an elderly patient with mental depression. International Psychogeriatrics, 31(10), 1525-1526.

Miracle Drug or Fad: Ozempic in Obesity Management

We all fell for it: Chloe Ting’s “Get Abs in Two Weeks” challenge during quarantine. Despite Chloe Ting's promising dramatic results, for most of us, those two weeks came and went without a single ab in sight. While gaining immense engagement and cult-like followings online, her workouts reflect a broader trend of quick-fix solutions for weight loss that have flooded the market amidst an obesity epidemic.

Despite a surge of ineffective fad diets and weight loss gimmicks, the basics of calorie reduction, balanced nutrition, and regular physical activity have remained as the cornerstones of sustainable weight management for American adults, 30.7% of whom are overweight and 42.4% are obese (1). However, for some, traditional methods yield slow or ineffective results, prompting the medical community to begin looking elsewhere for more reliable interventions. Enter Ozempic.

Originally developed to treat type 2 diabetes and manage blood sugar levels, Ozempic has garnered swaths of attention for its off-label uses as a weight loss solution, hailed by some as a miracle drug for obesity treatment. How does it work? Ozempic (semaglutide) belongs to a class of medications known as GLP-1 receptor agonists. Simply put, Ozempic mimics hormones in the body to help people feel full longer and reduce caloric intake (2). However, as with all drugs, there are side effects, and Ozempic is no exception. Its side effects are commonly gastrointestinal, including nausea, diarrhea, or constipation, but one side effect, weight loss, has captured the attention of doctors and patients alike (3). Indeed, Ozempic has been shown to achieve 5.6% and 10.9% weight loss after three and six months, respectively (4). So, is Ozempic a miracle drug, or is it merely a fad propelled by society's obsession with rapid weight loss? The answer likely lies somewhere in between.

The weight loss industry is notoriously prone to trends. Many weight loss drugs have gained popularity only to fade into the backdrop with the emergence of newer alternatives or as adverse effects become more known. Indeed, both historical and current examples of Fen-phen, Alli (orlistat), Qsymia, and many more pharmaceutical drugs empirically prove the tendency of patients to treat weight loss drugs as trends. Moreover, while Ozempic can aid in weight loss, it fails to address the root causes tied to obesity, including metabolic health, lifestyle factors, and emotional eating. In other words, Ozempic does not act as a long-term one-stop-shop for easy weight reductions. Certainly, stopping Ozempic prompts lost weight to likely return (3).

But is it right to promote the use of Ozempic as a weight loss solution? The sudden popularity and celebration of drugs like Ozempic raises concerns about body-image culture. The pressure to conform to societal standards of body size and shape is immense, and the marketing of Ozempic for weight loss both takes advantage of and feeds into this narrative. However, while Ozempic may offer promising results, it reinforces the notion that pharmacological interventions are the best, or only path, to achieving health. This perception of weight loss drugs overshadows the need for holistic approaches to weight management that involve diet, exercise, and mental health support. Critically, it risks reducing obesity management to a pill rather than addressing the complex socio-environmental factors that contribute to weight gain in the first place, such as sedentary lifestyles, food insecurity, and poor access to nutritional education.

Ultimately, Ozempic's potential as a tool for obesity management is undeniable. Its technical benefits, helping individuals achieve significant weight loss in particular, have earned it a place in discussions about modern obesity treatments. Although it may offer hope for many, Ozempic is not a silver bullet for obesity. Solving the obesity epidemic requires a multifaceted approach, one that includes education, lifestyle changes, government action, and more. So, at best, Ozempic is one step forward of many in solving the obesity epidemic. At worst, it's just another trend.

Graphic by Allison Chin

Reviewed by Aria Eaddy

References

1. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Overweight & obesity statistics. https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity

2. UC Davis Health. (2023). Ozempic for weight loss: Does it work and what do experts recommend? https://health.ucdavis.edu/blog/cultivating-health/ozempic-for-weight-loss-does-it-work-and-what-do-experts-recommend/2023/07#:~:text=How%20does%20Ozempic%20work%3F,food%20to%20leave%20the%20body

3. Ozempic® Side Effects | Ozempic® (semaglutide) injection. (n.d.). https://www.ozempic.com/how-to-take/side-effects.html 

4. Ghusn, W., De la Rosa, A., Sacoto, D., & Cifuentes, L. (2022). Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity. JAMA Network Open., 5(9). https://doi.org/10.1001/jamanetworkopen.2022.31982 

The Nutritional Void in Post-Operative Care

Imagine this: You’ve just undergone major surgery to remove cancer. After a week in recovery, you’re finally discharged and heading home. But upon arrival, you find yourself with a complete loss of appetite. The thought of food makes you nauseous, and you start rapidly losing weight. Who is responsible for ensuring you receive the nutrition you need during this critical time? Your healthcare provider may have had the precision and expertise to successfully perform your surgery, but should your care end after an operation? The answer should be a resounding no. Comprehensive dietary support during recovery is not just an optional add-on; it’s a vital component of effective postoperative care. 

Receiving nutritional care and dietary planning is critical for all postoperative patients, especially as many lose their appetite due to reactions to anesthesia, face increased cortisol levels triggered by stress, and have postoperative dietary restrictions like liquid diets (1). After surgery, patients experience stress, inflammation, and increased metabolic demands, all of which require adequate nutritional support for healing. A lack of proper dietary guidance can lead to insufficient nutrient intake, resulting in complications such as infections due to a weakened immune system, delayed healing, and reduced physical function (2). Despite this knowledge, comprehensive dietary support is often underrepresented in postoperative care plans, and malnutrition is one of the leading reasons for readmission to hospitals within 30 days of discharge (3). 

Systemic factors are making it increasingly challenging for individuals to access comprehensive postoperative care. Many healthcare facilities face resource limitations, which can lead to a prioritization of immediate surgical care over comprehensive recovery plans (4). Furthermore,

medical training frequently lacks a strong emphasis on nutrition, leaving many healthcare providers feeling ill-equipped to offer detailed dietary guidance (5). Patients from lower socioeconomic backgrounds face additional challenges, as many insurance plans do not cover nutritional counseling following surgery, and even with basic guidelines, these patients may lack funding to procure healthy and tolerable food choices, further complicating their recovery (6). Studies have proven the links between malnutrition and poverty, showing that many individuals living in poverty face financial limitations hindering their ability to access or afford nutritious food and fulfill their body’s calorie requirement, suggesting that such socioeconomic barriers can persist and negatively affect postoperative patients from lower socioeconomic backgrounds (7). Limited guidelines will not cut it; these patients need healthcare workers to provide detailed lists of potential food and liquid items that are both tolerable and nutritional, and patients should be able to consult a healthcare professional at all times when they need postoperative dietary assistance. 

The consequences of neglecting postoperative dietary support are profound: studies have shown that patients who receive tailored nutritional advice during recovery have better outcomes, including shorter hospital stays and lower complication rates (2). Conversely, those who lack this support are more likely to experience adverse effects that could have been mitigated with proper planning. The absence of comprehensive postoperative dietary support is not just a gap in care; it’s a disservice to patients navigating the healing process. By first recognizing the vital role of nutrition in recovery, we can utilize methods such as enhancing nutritional training programs for healthcare providers, encouraging teamwork among surgeons, nurses, and dietitians to create comprehensive recovery plans incorporating dietary guidance, educating patients about the importance of nutrition in recovery, and empowering patients to ask healthcare workers which foods are nutritious and tolerable for them, to help bridge this gap. It’s time for us to shift our perspective and ensure that postoperative care extends well beyond the operating room.

Graphic by Ariha Mehta

Reviewed by Emily Walsh

References

1. Bebko, G. M., et al. (2014). "Nausea and vomiting in postoperative patients: an evidence-based approach." Current Opinion in Anesthesiology, 27(6), 674-678.

2. Ho CY, Ibrahim Z, Abu Zaid Z, Mat Daud ZA, Mohd Yusop NB, Mohd Abas MN, Omar J. Postoperative Dietary Intake Achievement: A Secondary Analysis of a Randomized Controlled Trial. Nutrients. 2022 Jan 5;14(1):222. doi: 10.3390/nu14010222. PMID: 35011097; PMCID: PMC8747030.

3. University of Texas at Austin. (n.d.). Optimizing surgical outcomes with perioperative nutrition. UT Health Austin. Retrieved October 1, 2024, from https://uthealthaustin.org/blog/optimizing-surgical-outcomes-with-perioperative-nutrition

4. Kelley, K., Smith, J., & Johnson, R. (2020). Resource allocation and surgical outcomes: The impact of hospital resources on postoperative recovery. Surgery, 168(3), 486-493. https://doi.org/10.1016/j.surg.2020.03.002

5. Naylor, K., Burch, D., & Anderson, C. (2019). The role of nutrition in postoperative recovery: A review of current practices and training. Clinical Nutrition, 38(5), 2123-2130. https://doi.org/10.1016/j.clnu.2018.11.021

6. Huang, J., Kwon, S., & Ghosh, S. (2021). Barriers to nutritional care in postoperative patients: A systematic review. Journal of Nutrition Education and Behavior, 53(6), 455-463. https://doi.org/10.1016/j.jneb.2020.10.010

7. Siddiqui F, Salam RA, Lassi ZS, Das JK. The Intertwined Relationship Between Malnutrition and Poverty. Front Public Health. 2020 Aug 28;8:453. doi: 10.3389/fpubh.2020.00453. PMID: 32984245; PMCID: PMC7485412.