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Obsessive Compulsive Disorder - Dr. Mark Hyman
Mark Hyman MD The UltraMind Solution: Doctors often blame patients' psychiatric problems for their gut symptoms. They are "psychosomatic" illnesses created in the brain of people whose anxieties get the best of them.
But perhaps, very often, it just may be the other way around. Mischief in the gut causes disturbance in the brain. Fix the gut, and mood, behavior, and cognition all improve.
Many different factors affect gut (and brain) health:
• Unfriendly bacteria in the gut and other bugs like yeast that produce brain toxins
• Fermentation of starches from your diet that produce gas and toxic levels of ammonia
• Odd, partially digested food proteins that interfere with normal brain operations
• Activation of the immune system because of digestive imbalances that damage the protective barrier, which normally keeps the outside world from entering through the gut
Why are millions having all these gut problems?
The answer is that we are not very kind to our guts. We eat a SAD (standard American diet) that is low in fiber, rich in sugar, low in nutrients, and high in additives and chemicals, changing the ecosystem of our guts.
We are under chronic stress, which damages the normal intestinal barrier and affects the ENS.
Our drug culture pushes antibiotics, anti-inflammatories, aspirin, steroids, and acid-blocking medications that all disrupt our gut's ability to stay in balance and do its job.
And we are exposed to toxins such as mercury, which damage our normal gut function.
All in all, we live in dangerous digestive times.
An article by Dr. Henry Lin in the Journal of the American Medical Association1 mapped out a new way of thinking about irritable bowel and the psychological symptoms seen in irritable bowel patients.
He turns the current view on its head by saying that bacterial mischief in the small intestine (from bacteria that migrate up from the large intestine into a normally sterile territory) triggers an immune and nervous system response that sends messages back to the brain, which leads to insomnia,2 "sickness behavior," anxiety, depression, and impaired cognitive function.3 The gut immune system "speaks" to the brain, sending messages of inflammation, which trigger high levels of CRF (corticotrophin-releasing factor) in the hypothalamus (which increases stress hormones like cortisol)4, and changes neurotransmitter levels.5
Your gut is talking to your brain. And when these bacteria are involved, the communication isn't good.
So, bottom line: little bacteria in our gut start a cascade of immune and neurological events that stop our brain from doing what it was designed to do and create poor connections and communication all around.
This is one of the major ways your gut sends signals of ill health to your brain that can manifest themselves as any one (or perhaps all) of the conditions mentioned above and many others.
The most remarkable story of how bugs in the gut can affect your brain is from a woman who came to see me with the typical "whole list" of problems (which is why I call myself a "whole listic" doctor).
Most of her problems started in her gut–she had the usual diagnoses of irritable bowel with terrible bloating after meals as well as acid reflux, and she also had an autoimmune disease with joint pains and lots of inflammatory symptoms such as allergies and rashes.
She also had metabolic syndrome or pre-diabetes, thyroid problems, and chronic stress.
In addition to all these problems, she also suffered from debilitating obsessive-compulsive disorder. She was an educated, otherwise well-balanced human being, and there was nothing odd about her on the surface. But she could not pick up anything off her floor or clean or move anything in her house because of this weird obsession–for years!
In the ten years before she came to see me, she had become increasingly withdrawn because of her severe fatigue and her frustration and exhaustion with these quirky behaviors.
Actually she had been given many "diagnoses" over the years by many different doctors, including depression, anxiety, OCD, and sleep disorder. She also had severe fatigue for many years.
As a result, she took many drug cocktails over the years, including Ritalin and Dexedrine–or speed. And when I first saw her she was on Provigil (a new drug to wake up the brain), Depakote (a seizure drug given to OCD and bipolar patients), and the anti-depressants Celexa and Wellbutrin. She was also on a highly controlled new drug for sleep called Xyrem (which is the knockout date-rape drug, or GHB). This was quite a collection of mood stabilizers, uppers, and downers–this woman was a walking pharmacy!
We found she was allergic to gluten and dairy and she was making very odd peptides (little proteins) because of poor digestion. These are morphine-like proteins that result from incomplete digestion of casein (from dairy) and gluten (from wheat). These have been linked to many psychiatric disorders, especially autism and ADHD.6
She also had vitamin D and magnesium deficiency, which can contribute to depression and anxiety.
When we looked at her gut environment with a stool analysis, we found there weren't any of the normal healthy bacteria growing; her gut lining was inflamed; and some strangers had taken up residence in her gut, including yeasts and odd bacteria.
A gut is a veritable ecosystem–like a rain forest. There are more than five hundred species of bacteria living there, weighing in at a whopping three pounds. There is more bacterial DNA in your body than there is human DNA. All of the bacteria need to be in balance and in the right place (mostly in your large intestine) for your gut to function properly.
There are good bugs and bad bugs. The good bugs help digest your food, produce vitamins, control inflammation, boost immune function, and more. The bad bugs produce toxins; ferment starches (leading to bloating and gas); and tend to move into areas of the bowel like the stomach and small intestine, where they create terrible mischief. We generally want to get rid of the bad bugs and add more good bugs or probiotics to keep the gut healthy.
As part of this woman's gut cleanup, I gave her a new treatment pioneered by Dr. Mark Pimentel, of the University of California at Los Angeles School of Medicine.7 A nonabsorbed antibiotic called Xifaxin clears out abnormal bacteria in the small bowel. I expected her bloating and even some of her inflammatory symptoms to clear up by fixing her gut. But I was surprised by what she told me after she took the antibiotic.
Overnight her OCD disappeared; after years of unsuccessful treatment with psychotherapy and psychiatric medications, she was suddenly able to clean her entire house and pick up everything off the floor. The lights in her brain had come on for the first time in ten years.
A high level of ammonia in her blood caused her OCD. Ammonia is a neurotoxin that excites and damages brain cells and the mitochondria (the site of energy production in all cells). Bacteria in the gut produce ammonia, and when the liver can't detoxify it or there is just too much, it causes brain damage.
Every physician knows this because since the 1960s doctors have been treating a condition known as "hepatic encephalopathy,"8 a form of temporary insanity common in patients with liver failure. The brain dysfunction results from too much ammonia and is cured by clearing out the ammonia-producing bacteria in the gut with antibiotics. So this idea shouldn't seem strange to most doctors.
But it occurs in many patients–not just those with liver failure.
When we rechecked her ammonia level after treatment, it had returned to normal. After a few months, the bacteria came back and so did her OCD symptoms and her high ammonia level, and once again treating the bacteria cured her OCD. The link was clear.
If you want to learn more about how to overcome the symptoms of OCD and other "psychiatric" illnesses, see Dr. Hyman's new book, The UltraMind Solution..
http://www.ultramind.com/
[1]
Orr WC, Elsenbruch S, Harnish MJ. Autonomic regulation of cardiac function during sleep in patients with irritable bowel syndrome. Am J Gastroenterol. 2000;95:2865-71.
[2]
Anisman H, Merali Z. Cytokines, stress and depressive illness: brain-immune interactions. Ann Med. 2003;35:2-11.
[3]
Banks WA, Farr SA, Morley JE. Entry of blood-borne cytokines into the central nervous system: effects on cognitive processes. Neuroimmunomodulation. 2002-2003;10:319-27.
[4]
Rivier C. Effect of peripheral and central cytokines on the hypothalamic-pituitary-adrenal axis in the rat. Ann NY Acad Sci. 1993;697:97-105.
[5]
Carlson SL, Felten DL, Livnat S, Felten SY. Alternations of monoamines in specific central autonomic nuclei following immunization in mice. Brain Behav Immun. 1987;1:52-63.
[6]
Shattock P, Whiteley P. Biochemical aspects in autism spectrum disorders: updating the opioid-excess theory and presenting new opportunities for biomedical intervention. Expert Opin Ther Targets. 2002 Apr;6(2):175-83. Review.
[7]
Pimentel M, Park S, Mirocha J, Kane SV, Kong Y. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med. 2006 Oct 17;145(8):557-63.
[8]
Av SP. Hepatic encephalopathy: pathophysiology and advances in therapy. Trop Gastroenterol. 2007 Jan-Mar;28(1):4-10. Review.