We are experiencing an epidemic of brain-related disorders in the industrialized world.
Consider the following:
- One in eight seniors develops Alzheimer’s disease.
- One in eight children is diagnosed with autism, ADD, and ADHD.
- Up to 20 percent of people experience depression today (a tenfold increase since
1945), and depression is predicted to be the second-most disabling condition in the
world by 2020 (behind heart disease).
- Antidepressants are the most commonly prescribed drugs in the United States.
- Dementia affects almost 25 million people worldwide and is predicted to double every
twenty years until at least 2040.
These brain disorders are complex conditions with distinct causes. However, recent research suggests that they share at least three common factors:
- They are all inflammatory conditions. Inflammation is a cause, result, or exacerbating factor in every brain disorder I listed above.
- They are heavily influenced by gut health. The term “gut–brain axis” was coined by researchers to describe the close connection between the gut and the brain and to highlight the association between microbial imbalance of the gut, intestinal permeability (also known as “leaky gut”), and gastrointestinal inflammation and brain disorders.
- They are strongly influenced by nutrient composition and balance in the diet.
Cognitive disorders like Alzheimer’s and Parkinson’s disease have been linked to inflammation occurring in vulnerable regions of the brains. Anti-inflammatory drugs like NSAIDs have been shown to delay the onset and slow the progression of Alzheimer’s and dementia. Changes in the immune system that promote inflammation in the body have been shown to precede the neurological problems that characterize Parkinson’s.
With these underlying causes in mind, we are going to focus on dietary, lifestyle, and supplement strategies that reduce inflammation, improve gut health, and provide the brain with the nutrients it needs to function properly. Due to the complexity and severity of many of these conditions, we may need additional treatment options. But addressing these factors is an excellent starting place and may prove to be an exercise in setting a new foundation for successful health management.
To optimize neurological function, we need to make sure you are getting adequate nutrition from your diet—foods that promote GI health—and that you are avoiding foods that encourage gastrointestinal dysbiosis (also known as microbial imbalance in the gut) or inflammation. A low-FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, GAPS diet, and/or removal of additional food allergens may be needed in tough cases of cognitive disorders when the Paleo diet alone doesn’t bring about resolution of symptoms.
When it comes to resolving brain-related disorders, I use a two-step approach with my patients that addresses many of the primary factors that contribute to cognitive dysfunction. This is an “elimination” type dietary protocol well known to improve your nutrition while cutting out empty calories, balancing blood sugar and reducing inflammatory foods in the diet.
It begins with a Paleo 30-Day Reset Diet (see patient handout*) that is rich in high-quality, natural animal meats, bone broths, eggs, starchy and non-starchy vegetables, fermented vegetables, traditional fats, sea salt, and spices. The following foods are completely off limits during the 30- Day Reset Diet: dairy, grains, sweeteners, sodas, legumes, processed foods, alcohol, and industrial seed and vegetable oils. The second step is to reintroduce gray-area foods back into the diet, which serves to customize the Paleo diet for your unique needs and long-term dietary foundation.
PROTEIN AND AMINO ACIDS
A Paleo diet is rich in protein, which is ultimately broken down into its constituent amino acids. This of course assumes that you have a healthy GI function and can digest and absorb food. Adequate protein and amino acids are important for brain function. Amino acids provide the precursors for neurotransmitters (norepinephrine, epinephrine, dopamine, serotonin, gammaaminobutyric acid (GABA), acetylcholine, and many others). Amino acids build tissues, enzymes, and thyroid hormone; they work in the Krebs cycle to produce cellular energy; and they bind and excrete toxins from the body. The body therefore has a significant need for amino acids. Nutritionally speaking, providing protein and/or amino acids is a great way to support your body’s neurochemistry.
Eating too much lean protein (for instance, boneless, skinless chicken breast, lean ground beef, low-fat milk, and egg whites) can lead to lower levels of serotonin in the brain. This may contribute to depression and mood disorders in some people. Lean muscle meats and eggs are high in methionine. Methionine competes with tryptophan for transport across the blood-brain barrier into the brain. Tryptophan is the precursor (raw material) for serotonin and melatonin. Bone broth and fatty meats, on the other hand, are rich in glycine. Unlike methionine, glycine does not compete with tryptophan for transport across the blood-brain barrier. This is why a diet that includes bone broth and fattier cuts of meat can help prevent the depression and insomnia that some people may experience when eating a diet high in lean meat and eggs.
Fermented foods play an important role in restoring gut health, which is often compromised in brain disorders. First, the fermentation process “pre-digests” the vegetables and makes them easier to absorb. Second, fermented veggies contain probiotic microorganisms that help heal the gut. Fermenting vegetables can also make FODMAPs easier to digest. You can buy fermented vegetables at a health food store. Fermented vegetables should say “raw” on the jar, and they should be in the refrigerated section. The sauerkraut in the condiments section has been pasteurized and won’t have the same beneficial effect.
FODMAPs are specific types of carbohydrates that may contribute to bacterial overgrowth in the GI, thus harming brain function. The acronym FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are particular types of carbohydrate. FODMAPS are not well absorbed and can be easily fermented by gut bacteria. They also have an osmotic effect, which means they draw water into the large intestine. The fermentation and osmosis caused by these undigested sugars are a major cause of IBS symptoms such as gas, pain, and diarrhea.
FODMAPs can be problematic in people with brain disorders, since they often have an overgrowth of bacteria in their small intestines, or an imbalance of “good” and “bad” bacteria in their large intestines. If you have digestive issues along with depression, anxiety, difficulty concentrating, or another cognitive or neurological disorder, I suggest following the Paleo Rest with the low- FODMAP diet for at least thirty days. Please refer to the “Paleo Low-FODMAP Diet Food List” handout* when you are making these changes.
THE GAPS DIET
The Gut and Psychology Syndrome (GAPS) diet was developed by Dr. Natasha Campbell-McBride, a medical doctor with post-graduate degrees in nutrition and neurology. When her son was diagnosed with autism at age three, Dr. Campbell-McBride set out to learn as much about the condition as possible and was dismayed to learn that her own profession had few answers to offer her. After doing her own research, she became convinced that autism, ADD, ADHD, and other brain disorders originate in the gut. She developed a nutritional approach to treating these conditions and experienced dramatic results with her own son and in her clinic in the United Kingdom. I have also had great success using the GAPS diet to treat gut-brain disorders, especially autism spectrum disorders, ADD, and ADHD, as well as cognitive disorders like dementia and Alzheimer’s disease.
The GAPS diet is similar to the customized Paleo diet I use with my patients, with the following distinctions: It forbids all sources of starch (e.g., sweet potatoes, potatoes, plantains, etc.).
- It emphasizes the use of fermented foods and bone broths to restore healthy gut
microbiota and restore gut barrier integrity.
- It permits dairy products that contain little or no lactose, such as butter, ghee, homemade
kefir and yogurt, hard cheeses, and fermented cream. Fluid milk, soft cheese, and
unfermented cream are not permitted.
- The GAPS diet begins with an introductory period that allows only meat, fish, bone broth,
ginger tea, and small amounts of fermented foods, and progresses through several stages,
concluding with the “full GAPS diet,” which is much less restrictive.
The GAPS diet requires a significant investment of time and energy, but the results are often well worth the effort. Those most likely to benefit from the GAPS diet include:
- Children or adults on the autism spectrum or those who have ADD, ADHD, obsessive
compulsive disorder, sensory processing disorder, or other cognitive, neurological, or
behavioral problems. This is especially true when gut symptoms are present, but the
GAPS diet can also benefit patients who do not have gut symptoms.
- People with memory loss, dementia, Alzheimer’s disease, or Parkinson’s disease.
- People with depression, anxiety, and mood disorders that haven’t responded to a
customized Paleo diet and a low-FODMAP diet.
I think the GAPS diet can be an effective therapeutic approach, particularly for children with
behavioral disorders. However, it can have some downsides—especially if you follows the
introduction phase for too long. Since the intro phase is very low in fermentable fiber, it can starve the gut flora. This is helpful when a patient has excess pathogenic gut bacteria, but it also starves the beneficial gut bacteria, which is not desirable in the long run. I’ve seen many patients who benefited from the GAPS approach early on but experienced a decline in health over time. This was reversed when they added more fermentable fiber back into their diet. My recommendation is to use GAPS during the initial stages of recovery and then start adding some starchy plants and other fermentable fibers back into the diet.
See www.gapsdiet.com for an outline of the various stages of the diet, along with recommendations for books, websites, and GAPS-certified practitioners.
Many patients do better when they avoid grains entirely. This is particularly true for wheat, which contains gluten, wheat germ agglutinin, and other proteins that have been shown to provoke an inflammatory response. Celiac disease is an autoimmune disease, triggered by eating gluten, which leads to small intestinal villous atrophy. Celiac disease can manifest with psychiatric symptoms, which makes it a concern in those with cognitive disorders. The world’s leading expert on gluten and celiac disease, Alessio Fasano, MD, has recently reported that gluten triggers intestinal permeability in everyone who eats it, not just those with celiac disease.
Even patients who have non-celiac gluten sensitivity can be dramatically affected by eating gluten. Gluten sensitivity can affect nearly every tissue in the body, including the brain, skin, endocrine system, stomach, liver, blood vessels, smooth muscles, and even the nucleus of cells. Restricting grains, especially gluten, is therefore generally a good idea in patients with neurological disorders. It isn’t a life-long sentence, however. For some patients, properly prepared (soaked or fermented) grains may be a viable option in moderation if they are well tolerated.
The immune system uses IgA, IgE, IgG, and IgM immunoglobulins to help protect us from the outside world. An IgE antibody reaction can trigger anaphylaxis and is the most well-known cause of “food allergy.” However, patients may also have delayed food sensitivities (probably involving IgG antibodies and others) or they may have intolerances to foods (which are not immune mediated). Antibody-antigen complexes can accumulate, eventually depositing in organs or tissues, and cause symptoms if someone continues to eat a problem food. Or food sensitivities may cause chronic inflammation or irritation, preventing healing on other fronts. For these reasons, adverse reactions to foods may initiate or exacerbate mood disorders, attention problems, brain fog, and memory deficits. Testing is available to determine your food sensitivities, with variable accuracy and reproducibility, but the gold standard is elimination and reintroduction of the food in question.
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