Investigating a New Paradigm of Brain Health
When you first joined the ranks of functional medicine practitioners, I’m positive it didn’t take you long to meet patients with complaints like these:
- “I’m tired all the time.”
- “I have frustrating bouts of brain fog and forgetfulness.”
- “No matter what I do, I still feel so depressed.”
- “I’m concerned that I may have some sort of neurodegenerative disorder.”
These patients, and countless other individuals like them who have not entered the doors of our practices, need our increasing expertise and the ongoing development of our understanding of neurological disorders.
Often, our patients’ mental and neurological symptoms are approached with pharmaceuticals, with their myriad side effects, and trial-and-error prescribing. Worse yet, the results of one-size-fits-all diagnoses and prescriptions are often inadequate and deepen frustration for the patient.
For these reasons and more, a thorough understanding of the strong connection between the brain and the gut is vital to offering a high level of quality of care.
The Gut and Brain Symbiosis at Work
Considering the gut when it comes to neurological symptoms may not sound intuitive at first. But the intrinsic connection between the health of the gut microbiome and the brain means that the key to addressing mental and neurological issues often lies in the digestive tract.
The digestive tract houses a microbiome comprised of over 100 trillion microbial cells. These powerhouse cells, when properly balanced and nourished, are responsible for a vast collection of functions within the body. Among the many important roles of the gut microbiome, it acts as a “mini brain,” which is better known as the enteric nervous system.
The results of one-size-fits-all diagnoses and prescriptions are often inadequate and deepen frustration for the patient.
The enteric nervous system (ENS) does not function the same way as the “big brain.” Its primary function is to regulate the digestive system from salivation and swallowing to nutrient absorption and elimination. However, the ENS still communicates with the brain, and researchers are increasingly finding patterns of comorbidities that indicate a strong connection between mental and neurological dysfunction and gut dysbiosis.
For instance, there is such a strong correlation between depression and IBS that it is not uncommon for a traditional medicine doctor to prescribe an antidepressant for patients with IBS. This approach may offer some relief to a patient for a period, but it fails to adequately address the needs of the ENS that, if resolved, could offer more complete relief.
The intrinsic connection between the health of the gut microbiome and the brain means that the key to addressing mental and neurological issues often lies in the digestive tract.
In a holistic functional medicine model, a practitioner works with their patient to evaluate their neurological and mental health symptoms as part of a complete workup going from top to bottom. Then, they locate and identify the connections throughout the patient’s systems that may be causing symbiotic dysfunction.
Using an IBS patient as an example, a knowledgeable doctor would tackle both IBS and mental health symptoms by first focusing on healing the patient’s gut microbiome.
A Dynamic Relationship and a Distinct Opportunity
Because gut health is so intricately tied to brain health, skin health, heart health, and more, it might seem that an all-out effort to “microbe bomb” the gut would be high on the list of strategies. The reality is more nuanced than that.
Different presentations of gut dysbiosis through neurological or mental health symptoms mean you must spend the time to find the underlying deficiencies and target treatment and support for the patient. To see this more clearly, let’s consider two case studies.
Consider Janine, a middle-aged mother with a busy lifestyle caring for her children and working full time. Janine has an intake appointment with you, her new doctor. She reports that she is struggling with increasing symptoms of depression, including difficulty waking, persistent feelings of sadness, irritability, and forgetfulness. She explains she has a family history of dementia, and these symptoms have her worried about her own future, contributing to a growing anxiety.
Different presentations of gut dysbiosis through neurological or mental health symptoms mean you must spend the time to find the underlying deficiencies and target treatment and support for the patient.
Then there is Tomás, a young adult who was diagnosed with Crohn’s disease as a child and has struggled to hold a job due to frequent acute flare-ups. At his intake visit with you, his main complaints revolve around his Crohn’s symptoms, especially abdominal pain, diarrhea, loss of appetite, and joint pain. You observe that his speech seems slow, and he often seems to forget what he is saying or seems confused as you ask questions.
In each of these cases, you start with the initial complaints. Then you begin to assess from top to bottom to ascertain all the underlying issues and mechanisms causing the patient’s symptoms, both the ones that initially motivated the patient to walk into your office and the ones you uncover through your thorough intake screening.
Uncovering More Clues in the Brain and Gut
As you begin to understand the dynamic and intrinsic relationship between the functions of the brain and the health of the gut microbiome, it becomes more natural for you to see the ways that a dysfunction in the brain or mental health issues will cause imbalances within the gut and vice versa.
As you examine Janine and Tomás, you discover additional clues to where their bodies require the most support.
In Janine’s case, you learn of her ongoing issues with recurring bouts of constipation and discover that she has become more sensitive to painful stimuli in recent years. With this information, you can go on to discover that she has developed low serotonin, causing her depression symptoms and low motility in the gut, along with heightened sensitivity to pain.
Then, when reviewing Tomás’s symptoms, you uncover that he also has unexplained back pain. Your exam finds that he has peripheral neuropathy and weakness in his hands and feet.
In neither case did your patient see a connection between what they considered their primary concerns and other symptoms, but a well-trained clinician will see the connections and be better equipped to support their patients. This is why it is so imperative to learn how to approach the gut and brain as the interconnected systems that they are.
Why the Solution Is NOT Just Probiotics
After you understand the value of treating both GI issues and neurological issues in concert, it can be tempting to default to treating every patient you encounter with high levels of prebiotics and probiotics. However, you’re likely to see much better results by prescribing a dietary and supplementary approach that work in tandem.
This strategy will often be a much better solution for healing and symptom management. It generally involves strict dietary protocols to nourish the microbiome, rebalance the GI tract, and reduce dietary antagonists to the overall goal of optimal GI health.
Though certain probiotic-rich foods may be a significant part of this strategy, rarely is an overhyped probiotic pill a part of the correct approach. Rather, it is absolutely essential to learn the balance of food, supplements, exercise, and lifestyle modifications that can properly support the body.
Though certain probiotic-rich foods may be a significant part of this strategy, rarely is an overhyped probiotic pill a part of the correct approach.
In addition to considering a more well-rounded protocol for your patients, it is key to consider the order in which to tackle certain symptoms to manage patient health successfully. For instance, a patient suffering from deep and pervasive mental health symptoms may struggle to make other lifestyle or diet changes successfully while in the throes of apathy or anxiety, necessitating an initial focus on their mental health symptoms.
On the other hand, a patient facing significant pain, inflammation, neuropathy, or other acute symptoms may require that you focus on first reducing the impact of these issues before addressing the underlying dysfunction.
Holistic Health from Top to Bottom
A protocol that is tailor made for the individual patient is key to their well-being—and your success as their practitioner. While the brain and gut have an intricate and comprehensive connection, the perceived severity and discomfort of a patient’s symptoms will dictate the best approach. Additionally, you can begin to help patients anticipate potential GI issues due to neurological issues or be on the lookout for potential neurological or mental health issues springing from known GI problems.
Getting to this level of knowledge as a functional medicine practitioner requires training and expertise. This is where Dr. Randy Vawdrey, NP-C, enters the picture. With his new course, Treating Complex Neurological Conditions with Precision, you’ll learn strategies for diagnosing and treating neurodegenerative diseases, autoimmune disorders, and more to transform your patients’ outcomes.
With over 25 years of experience, beginning with his 1998 graduation from BYU, obtaining multiple certifications and contributing to the understanding of care for traumatic brain injury (TBI), COVID long-hauler’s syndrome, and the prevention and treatment of dementia and other neurodegenerative conditions, Randy is an expert in the holistic approach to brain care.
We’re excited to complement Dr. Kharrazian’s educational offerings with this incredible masterclass from Randy. Be sure to sign up today!
