People love the concept of “detox” and a lot of different strategies such as juicing and fasting, and “cleansing” have been proposed to achieve this goal. Even though the concept goes back thousands of years, most are based on unsubstantiated pseudoscientific concepts that “cleansing” your digestive tract has health benefits over and beyond a general feeling of wellbeing. For example, converting fruits and vegetables into tasty juices deprives your gut microbes of their natural food (undigestible fibers) and results in rapid sugar absorption and subsequent insulin spikes. On the other hand, short term intermittent fasting has little to do with “detox” but may improve your gut microbial composition in a way that is good for your health.
However, the term detoxification borrowed from the substance abuse field is quite appropriate for the treatment of the clinical syndrome “food addiction”. The prevalence and underlying biological mechanisms of this syndrome are well documented in numerous scientific studies. Genetically predisposed individuals can develop such uncontrolled eating behavior when exposed to unlimited amounts of salt, sugar, or fat. Such hedonic eating behavior is associated with a remodeling of the brain-gut-microbiome axis, including a disinhibition of brain reward system, similar to the brain changes in individuals with substance abuse. As pointed out in Michael Moss’s excellent book Salt, Sugar, Fat, marketing experts in some major US food companies are well aware of this target population and have designed their products (high in sugar, fat and salt) to get young people “hooked” on their brands. Not all food companies are to blame, however, and some have undertaken unprecedented efforts to reverse this trend.
The recommendations detailed in Brooke Alpert’s book are a practical, short term approach to detox kids with sugar addiction, but are no substitute for a fundamental switch to a healthy
Mediterranean style diet, high in plant based foods, and with minimal sugar and animal fat, regular exercise, and regular stress management.
I was invited to speak at the Annual Meeting of the American Psychiatric Association (APA) recently in a debate addressing the question: Can Gut Microbiota Affect Mental Illness? The event was organized by Erika Nurmi, MD from the Semel Institute at UCLA and had a prestigious panel of discussants including James McCracken, MD (UCLA), Chadi Calarge, MD (Baylor) and Michele Pato, MD (Suny Downstate). The debate attracted an audience of some 700 attendees, reflecting the considerable interest of the topic to psychiatrists. I emphasized the growing evidence from human studies supporting a role of the gut microbiome in mental health, in particular in depression, as well as the growing evidence for a role of a healthy, “non-inflammatory” diet as an adjuvant therapy. However, I cautioned about the premature acceptance of pro- and prebiotics as effective therapies for depression (“psychobiotics”) and of stool testing for dysbiosis in the clinic.
Also, at the end of the session I was interviewed by David Careon and Jessi Gold from Stanford for the podcast Psyched.
I just spoke at an international microbiome symposium sponsored by the Falk Foundation and organized by Dr. Gerald Holtmann in Brisbane, Australia.
The conference highlighted the rapid progress that is being made in identifying the role of the gut microbes in a wide range of disease areas, including inflammatory bowel diseases, IBS, rheumatoid arthritis, pulmonary disease, liver disease, obesity and depression.
Among the many topics, a presentation by Professor McGuckin about the role of the mucus layer of the gut lining was of particular interest. The mucus layer has many crucial functions ranging from its role as barrier between microbes and gut lining, to being the home and food supply for certain microbes. Stress and an unhealthy diet (high fat and sugar, emulsifiers and artificial sweeteners) can have a detrimental effect on it. In turn, a compromised mucus layer plays a major role in the leakiness of the gut.
I was recently invited by Professor William McCarthy from the UCLA School of Public Health to participate in an Expert Roundtable on Added/Free Sugar at the Luskin Center at UCLA. The meeting was sponsored by the Kaiser Permanente Policy Institute in partnership with the American Heart Association and hosted by Drs. Sue Babey and William McCarthy from the Center for Health Policy Research at UCLA. Kaiser Permanente wants to be a leader in clinical and policy approaches to reducing excess added sugar intake.
A wide range of topics were discussed at the meeting from the detrimental effect of excessive fructose consumption on metabolic health and on fatty liver disease to legislative approaches to reducing population access to sugary beverages. The task to stand up against the powerful lobby behind the farm and food industry (adding sugar and high fructose corn syrup to just about everything we eat) is enormous. However, some companies have become partners in this effort. Jessica Sperling from Dannon (now DanoneWave) gave an excellent example of the laudable efforts this company makes to reduce sugar in dairy products and their example will hopefully be followed by others.
In the last 5 days I spoke at scientific meetings in NYC, New Orleans and UCLA on each of these topics. The growing interest in the topic of brain gut communication by specialists working in very different areas of research would not have been imaginable only a couple of years ago!
Question 1: What do inflammatory bowel diseases (IBD), obesity/food addiction, and depression/anxiety have in common?
Answer: Current research suggests that they are all disorders involving the brain gut microbiome communication. A recent review by Caltech investigators reviews the latest evidence on the topic of brain microbiota communication (https://www.ncbi.nlm.nih.gov/pubmed/27814521)
Question 2: If the gut microbes do play a role in all 3 disorders, are there shared therapies targeted at the brain gut axis?
Answer: Current evidence suggests yes. Both mind based therapies (like mindfulness based stress reduction and cognitive behavioral therapies), as well a diet high in plant based foods and low in animal products (like the Mediterranean diet) are beneficial in all three diseases. Read more about it in The Mind-Gut Connection Book.
Further reading: Sharon G, Sampson TR, Geschwind DH, Mazmanian SK. The Central Nervous System and the Gut Microbiome. Cell. 2016 Nov 3;167(4):915-932. doi: 10.1016/j.cell.2016.10.027.