The third tier in treatment: Attending to the growing connection between gut health and emotional well-being

A Novel Nutrient Intervention of Probiotics, Glutamine, and Fish Oil in Psychological Distress: A Concurrent Multiple Baseline Design

Objectives: The aim of this study was to investigate whether a combination of nutrients designed to promote gut and brain health also lowers psychological distress. The hypothesis is that a probiotic with fish oil, and glutamine supplement will reduce psychological distress. Design: A multiple baseline design was used to collect data from seven naturopathic patients in private naturopathic clinics in Australia. Patients were between 18 and 65 years of age, and had a Kessler-10 (K10) score between 16 and 30 and symptoms associated with mild gastrointestinal discomfort experienced several times most weeks for 3 months. They were randomized into one of three pathways to stagger the introduction of the intervention. Interventions: Participants received either a supplement incorporating a probiotic formulation (including Lactobacillus rhamnosus), a glutamine powder formulation, and fish oil, or matched placebos. The primary outcome measure was psychological distress as measured by the K10 scale of psychological distress. Results: The data showed a general trend toward lower K10 scores during the active phase compared with the baseline phase, with a marked reduction in the variances between phases. After controlling for time and baseline values, no significant difference between the phases for the K10 and the Perceived Stress Scale was found, but there was still a significant reduction in symptoms on the Gastrointestinal Symptom Rating Scale. Conclusions: A combination of a probiotic formulation, a glutamine powder formulation, and fish oil did not affect psychological distress and perceived stress, but had a significant beneficial effect on gastrointestinal symptoms in patients with high distress and concurrent gut symptomology. Clinical trial registration number: ACTRN12620000928910.

A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health

The opioid crisis has reached epidemic proportions in the United States with rising overdose death rates. Identifying the underlying factors that contribute to addiction vulnerability may lead to more effective prevention strategies. Supply side environmental factors are a major contributing component. Psychosocial factors such as stress, trauma, and adverse childhood experiences have been linked to emotional pain leading to self-medication. Genetic and epigenetic factors associated with brain reward pathways and impulsivity are known predictors of addiction vulnerability. This review attempts to present a biopsychosocial approach that connects various social and biological theories related to the addiction crisis. The emerging role of nutrition therapy with an emphasis on gastrointestinal health in the treatment of opioid use disorder is presented. The biopsychosocial model integrates concepts from several disciplines, emphasizing multicausality rather than a reductionist approach. Potential solutions at multiple levels are presented, considering individual as well as population health. This single cohesive framework is based on the interdependency of the entire system, identifying risk and protective factors that may influence substance-seeking behavior. Nutrition should be included as one facet of a multidisciplinary approach toward improved recovery outcomes. Cross-disciplinary collaborative efforts, new ideas, and fiscal resources will be critical to address the epidemic.