Kelly Brogan used to be a pharmaceutical cowboy. That's how, in her close-talking, rapid-fire way, this powerhouse in skinny jeans describes her old life as a swaggering Bellevue-trained shrink. She had an exhaustive knowledge of brain-soothing antidepressants, and for years she used them confidently to lasso her patients' worst psychological beasts. It wasn't until she found herself prescribing powerful antidepressants to pregnant women 6 years ago that something snapped. "I was pregnant at the time myself," Brogan, now 36, says, "and I thought, I would never take these medications."
So she trained her restless, analytical mind on the psychiatric status quo. It didn't look good: Over recent decades, the swelling number of prescriptions for psychiatric drugs has done nothing to stem another rising tide—that of mental illness diagnoses. There's a debate raging about whether SSRI antidepressants are any better than placebos for people with mild and moderate cases. After some deep consideration, Brogan came to the radical conclusion that there was absolutely nothing worth saving about the way she had been trained to alleviate the mental suffering of her patients. "I realized the emperor has no clothes," she says. She decided to turn her back on antidepressants.
Psychiatrist Kelly Brogan’s very public stance on medication is radical and sometimes divisive. But, she says, her patients have found happiness and calm by forgoing pills in favor of supplements and diet changes.
Acting on a new hunch, Brogan set about healing people's minds via their digestive systems. Her patients' stories, plus a growing area of research, inspired her to banish antidepressants like Lexapro in favor of lactobacillus and spend more time discussing gastrointestinal symptoms than emotional ones. The results spoke for themselves: Her women-only Manhattan practice sprouted a waiting list of 6 to 8 months. "I can't even remember the last patient I wasn't able to help," she says.
Brogan's ideas are extreme, but she is far from alone on this medical frontier. A quick scan of the latest self-help books and Facebook groups—some fringy, all passionate—turns up scores of clinicians and patients who believe that they have healed the mind by healing the gut, their conviction that this is the right path almost religious in its fervor. (Brogan is a one-woman cottage industry, with more than 23,000 Facebook fans and a blog that gets 20,000 hits a week.) The claim is remarkable and increasingly convincing: Probiotic supplements and a change in diet can, in effect, rewire the brain.
The unlikely, invisible driver behind the miracles: bacteria. Over the past several years, research on the bugs that live on and inside our bodies has exploded. As the health savvy are becoming increasingly aware, we have at least 10 times as many single-celled bacteria floating around in us as human cells, and the majority of these roughly 100 trillion critters are located in the gut—mostly in the colon, where they play an essential role in human digestion. (Without them, we couldn't break down the plant fiber we eat.) Much of the research has focused on how the microbiome might affect what can go wrong in the gut—for instance, in digestive disorders such as IBS or in obesity—because bacteria affect how food is broken down and converted into energy. But one of the hottest areas of research, and arguably the most fascinating, is the connection between gut bacteria and our mental health.
We've known forever that our emotions affect our digestive systems, as anyone who's had a sour stomach before a work presentation has gathered. What these new accounts tell us is that the brain-to-gut effect works in the opposite direction, too. More significantly, they introduce bacteria as a compelling, previously unconsidered player that can communicate, directly or indirectly, with our brains to determine our moods and, perhaps, our most basic sense of who we are. Some scientists now talk about the gut-microbiome-brain axis.
Gut bacteria was the last thing Maureen Olbon would have considered when, 4 years ago, she had a very bad stretch at the state hospital where she worked outside of Durham, NC. A powerfully built schizophrenic patient suddenly lost it and lunged at her, trapping her in a choke hold. Two months later, another patient punched her in the face with such force that she slammed against a wall. The attacks left Olbon a physical and mental wreck. "I couldn't make people understand the terror I was feeling," Olbon, 62, says. She saw several psychiatrists and was prescribed a pharmacopoeia of prescription meds—SSRI antidepressants, antianxiety drugs, antipsychotics. "It felt like I was having a lot of people do things to me, but I wasn't feeling a benefit," she says. "I was on a slide, and it was downward."
Steady and incremental relief came through her work with Natalie Sadler, a University of North Carolina–trained psychiatrist who, like Brogan, had moved her practice away from conventional antidepressants and toward probiotic supplements and diet to address just about every form of psychic distress. "I totally changed my diet—no gluten, no processed foods," Olbon says. Her anxiety calmed, and she tapered off the antidepressants. She gives the most credit to the probiotics: "When I stop taking them, I feel it: My stomach goes off, I stop sleeping, and my mood starts to drop."
( Illustration by Emily Kate Roemer )
Believing in a gut-microbiome-brain axis repositions the purpose of food from human nourishment to nourishment for the microscopic ecosystem inside us. Brogan starts virtually every patient who walks into her office on a 4-week, one-size-fits-all therapy: Eat only organic, non-GMO, unprocessed foods, with no grains, no dairy except eggs, and no alcohol or coffee. Lots of vegetables is key. And so is fat: olive oil with its monounsaturated fats; wild fish with its omega-3 fatty acids; and, more controversially, plenty of meat (pasture-raised, of course) with its saturated fat and major load of vitamins and minerals.
This prescription may sound familiar, even trendy—the up-with-fats, down-with-grains message is straight out of the Paleo diet. Whether this is in fact the best way to eat for everyone's gut is an open question; the scientific evidence is all over the map. But unquestionably, fiber-heavy plant foods feed the friendly bacteria in the gut, and, Brogan argues, dietary fat replenishes cells in the brain, itself made up mostly of fat. "I had a patient a month and a half ago who had just gotten out of a psych hospital and had been on myriad drugs for 12 years," she recounts. "All we did for the first month was this diet, plus 5 minutes a day of breathing work and some exercise, which she was already doing. She came back with tears in her eyes and said, 'For the first time in my adult life, I haven't had a panic attack in 30 days.' "
A cure for our most common psychological ills that's so simple it doesn't even require a prescription for antidepressants? Two years ago, UCLA gastroenterologist Kirsten Tillisch authored the most widely admired of the modest smattering of existing studies on probiotics and the brain. Twice a day for 4 weeks, she fed a group of 12 women a yogurt specially blended with live probiotic bacteria and compared their performance on a test with that of a group who had eaten a dairy product that contained no probiotics. Both groups aced the test, but in the women who hadn't been on the probiotic-yogurt regimen, parts of the brain associated with hyperalertness and anxiety lit up more strongly on an fMRI imaging study.
According to Ted Dinan, a professor of psychiatry at University College Cork, in Ireland, and one of the world's leading researchers on the subject, there are three basic mechanisms underlying the astonishing connection between these lowly microorganisms and our very personalities: (1) Bacteria that live in the gut (or travel through it aboard some yogurt) are necessary building blocks in the production of neurochemicals there, like serotonin and dopamine. (2) That impact on neurochemicals in turn has an effect on the secretion of stress hormones like cortisol. (3) Gut bugs also play a vital role in regulating the immune system and the inflammatory response it can launch when things go haywire. Inflammation is now widely considered to be one underlying cause of depression.
Happy chemicals, stress hormones, brain-polluting inflammation: It's a trio of forces that govern our mental health. Scientists are just beginning to unravel their collective effects.
Brogan may saunter confidently into the future of psychiatry armed with nothing more than food and supplements, but her colleagues tread more cautiously. James Greenblatt, an assistant clinical professor of psychiatry at Tufts University School of Medicine, is most interested in cases in which he has evidence of bacterial and psychiatric imbalance—for instance, the 1 in 10 of his psych patients who show elevated levels of one potentially pernicious type of bacteria, clostridia. By-products of this bug interfere with the way the neurochemical dopamine gets processed in the colon. When dopamine builds up—as it does, Greenblatt believes, in these clostridia-afflicted patients—you get severe forms of psychiatric illnesses like ADHD and OCD. Probiotics are his treatment of choice, along with antibiotics in severe cases. "For these people, the results can be so dramatic," he says. Another 4 in 10 of his patients will be helped by probiotics, just not so dramatically, he says.
Greenblatt notes that he's successfully treated hundreds of patients with elevated clostridia, including a high school girl whose transformation from out of control to normal was so extraordinary, it was covered by ABC News, among other outlets. The story set in motion a second "miracle cure," that of a middle-aged man afflicted with compulsive hair pulling. He read about the case and was inspired to treat himself with probiotics—with complete success, he says. He sent Greenblatt a grateful email—and that story made the Boston Globe.
Peer-reviewed research this is not, so it's no surprise that mainstream psychiatrists are slow to get on board. No one has yet done a rigorous controlled study measuring the effects of probiotics on people with depression or anxiety disorders or looked at whether the microbiomes of those people look reliably different from the microbiomes of the rest of us. "There is an emerging research literature that is compelling," says Thomas Wise, a George Washington University psychiatrist who is eager for answers, "so you can't say the microbiome is hocus-pocus. Gut bacteria affects the brain in many ways. But how does that relate to depression? The human data is minimal."
Tillisch, whose promising study is so widely cited, agrees. "Who should take a probiotic? What dose? Which strains of bacteria? We're just not there yet." The uncertainty leaves doctors recommending multistrain products that include lactobacillus, which is found in most fermented foods, at a range of doses (VSL #3, a powerful probiotic often recommended for digestive disorders, contains a whopping 112.5 billion colony-forming units, or CFUs). They're all available OTC. Tillisch is hopeful that the expensive, complex studies currently under way will someday provide more specific probiotic drug regimens that pass muster. Until then, she says, "I'd recommend trusting our historical wisdom and our common sense and trying a fermented food, like yogurt, which has been around for a long time."
While Brogan is also a fan of fermented foods, she's confident enough to brandish the less-proven tools in the new gut-brain toolbox, too. She points to a recent case, a 30-something wife and mother with a secure career who was plagued not by extreme psychiatric symptoms but, rather, by ordinary unhappiness. "Many of us live in this haze of chronic stress," Brogan says. "And even when we see a doctor for specific symptoms, we're either dismissed or given a prescription for antidepressants—and the impression that we just need to find a way to 'manage.' " With dietary changes in place, the woman's anxiety dissipated by more than half. After she started taking a high-dose probiotic, she was—to use an old-fashioned word—cured. "The last time I saw this patient, I said, 'Have a nice life,' " Brogan says. "She had no more need to see me."
This bacteria-slinging cowboy has written up the case history for a medical journal. Only time will tell if stories like this one become an entirely new paradigm for how we treat our brains.
Original article and pictures take www.prevention.com site
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