I recently did some Functional Medicine tests on myself and ended up learning a few things which caused me to completely re-conceptualise my understanding of myself. This wasn’t about understanding my body in a different way, but rather about seeing my actions, behaviours and choices in an entirely different light once I had learned a little bit more about the driving mechanisms of my chemistry and my biology.
When I realised that I had been carrying around a misunderstanding and misinterpretation of my behaviours, it made me remember just how connected our behaviour and our physiology are – and how often we forget this when we become lost in the idea of ourselves. Quick to make assertions about character, identity and ‘self’ based on what we do, think or feel – last week was a solid reminder for me that at the root of all of us is a body and a biochemistry that is constantly communicating and influencing the things we think of as ‘us’.
Who Do You Think You Are?
Every day we are making judgements about ourselves and who we are. Our conscious minds draw inferences about our ‘identity’ based on the interpretation of the things that happen within us – our internal signalling, our feelings, our sensations of reality, our thoughts and our understandings.
But our interpretation of how we think, feel and act is also powerful. We do this based on our frames of reference, more often than not seeing these elements of ourselves as evidence of our character, innate personality and ‘who we are’.
We rarely factor into our understanding of behaviour and thinking the notion of biology. But biology is fundamental to the very organ of thoughts: the brain. So who are you really? Are your thoughts and behaviours a reflection of your ‘self’? Or is your biology driving those behaviours and simultaneously influencing your interpretation of who you think you are?
In some of my recent blog posts I have covered mental health conditions, and I do find that I am more and more drawn to this topic. Whilst separating the body into individualised systems and trying to suppress symptoms is dangerous, separating the mind from the body and treating mental health as if it emerges out of a completely different source than physical health is even more so.
The way we understand and interpret our thoughts, emotions, feelings and behaviours is a fundamental cornerstone of our idea of ourselves. And this idea of ourselves is the foundation of absolutely everything we do in life: from the confidence we feel, the way we interact, the self care practices we engage in, our sense of self worth and our view of our relative place in the world. Our self-awareness therefore has a profound and life-changing impact on our physical wellbeing. Your sense of yourself literally changes your potential for everything. And our sense of self is often founded on a flawed interpretation of our psyche, rather than understanding our psyche as a representation of our neural networks (which are heavily influenced by biology).
The world of psychiatric medicine as it currently stands views the brain as a vat of neurotransmitters which can be directly manipulated using chemicals to alter brain states. Similar but distinct, the world of psychology views the mind and its thoughts as the product of past experiences which much be understood and processed in order to move forward. Whilst a few brave professionals are willing look at alternative, broader, concepts, very few psychiatrists are hanging up their prescription pads – and very few psychologists are asking where their clients’ thoughts and feelings come from.
And as human beings we are keen to think that physical issues are the result of physiological causes, and that emotional and mental difficulties are related to flaws in psychology/mind or emotions – and our character.
We think that our feelings are hurt by experiences and our bodies are hurt by things.
The Brain is An Organ
This is where the model of Functional Medicine can offer true service to those who are struggling with mental health issues. Because the fundamental question within Functional Medicine is “why?”, practitioners are devoted to uncovering the roots of psychological distress.
The brain is intricately tied into the physiology of the whole, as my last blog post on SSRIs and depression highlighted. It is dependent upon nutrients and nutrition. And whereas my previous post spoke about nutrient absorption and genetically-predisposition to nutrient imbalances, here I want to take a slightly different approach.
I want to highlight today how your sense of self emerges out of the state of the brain, but the brain is dependent upon many physiological factors. Therefore, if you change your biology, you may just change your behaviour. You may then have to completely reevaluate who you think you are as a person.
I alluded to the idea of thinking in the colour of our biology whilst populating that picture with the constructs from our experience. By this I meant that our biology determines the backdrop to the structured thoughts of our minds.
Therefore, if you compromise your biology, you compromise your capacity to think and you define the way you are able to think. We also can’t seek to change our way of thinking by focussing on our emotions alone. Whilst I am a big believer in the power of psychological self-awareness and emotional self-evaluation…
If the biology isn’t giving the right ingredients to the mind, the way you think (and therefore who you think you are) is fundamentally altered.
So what can physically alter the chemistry in the brain? What are the things which are important to watch out for in terms of mental health being an emergent property of physical health?
And more importantly, are you capable of real change – to what you perceive as your character and identity – just by monitoring and altering factors within your physiology?
The most zeitgeist topic across all of healthcare at the moment is the microbiome. This word is used interchangeably with gut biome, microbiota, gut bugs etc. etc. Essentially, however, science has come to recognise that there is a whole ecosystem living in us (and on us) throughout life.
Bugs got a bad reputation in the early days of modern medicine when the most dangerous threat to human life was bacteria and viruses, so-called communicable diseases. Epidemics of infectious diseases used to be the leading cause of illness throughout the world. The discovery of antibiotics altered the course of medicine. Suddenly we had something to attack these diseases and we developed the notion that ‘bugs are bad’. We have gone about killing as many as we could ever since.
Despite the growing understanding of gut bacteria today, the notion that some bugs are actually good for us is only recently gaining traction and credence. We now accept that we co-evolved with an ecosystem of bacteria which populates our gut and actually the entirety of our bodies, and that these bugs play an as yet unquantifiable role in our lives.
I plan to write a longer post on whether the science of the microbiome as it stands allows us to fully condone the many modern treatment approaches for tweaking microbial balances etc. For now, suffice to say that we do know that gut microbiome health is fundamental to not only digestive wellbeing, but to our survival as human beings.
But the brain and gut bugs is FASCINATING. Here is where science gets geeky, weird and just a little bit fabulous. Because it may not be that bugs just keep us alive, help us digest food and create gut equilibrium. It turns out they might change our behaviours, our thoughts – and perhaps, in so doing, alter our sense of self.
Disclaimer: For those of you who like your research double-blind, randomised, controlled, human-only, empirically verified and tied up with a beautiful red ribbon as “conclusive” – when you step into the world of microbiota you (currently) have to surrender to the imponderables just a little bit. Designing studies that can prove causality and define the precise relationship of bugs to humans is not only challenging, but the world of the microbiome is truly where individualised medicine comes into play. No two microbiomes are the same… so – this is the cutting edge but it isn’t ironclad (this varying degrees of certainty is what that next blog post will cover)…
What we basically know is that the gut bugs are saying something to our brains, and also influencing behaviour – and not just food-based behaviours, but stress-based responses too. A brilliant review paper by Mayer et al in the American Journal of Neuroscience (2014) toured through the (admittedly mostly animal-based) literature, describing how stress states were able to regulate the population of gut bacteria, but also how the alteration of gut bacteria (such as in the case of breeding bacteria-free mice) could cause an overactive hypothalamic-pituitary-adrenal (HPA) axis, which is what governs our mental and physical responses to stress. This HPA axis effect was reversed by adding in some Bifidobacteria – a so-called ‘good bug’. This paper also reviewed the studies for both the antibiotic and probiotic effects on the microbiome and the subsequent links to brain function, chemistry and behavioural characteristics. We may not be sure of the mechanisms, but we do know something is happening.
A quick PubMed search will soon have you drowning in resources, but this is such a common discussion that popular journals such as Scientific American and Nature have synthesised some of the latest data. It is clear that we don’t know everything, but our central nervous system and our gut are definitely communicating. Whether through activating the vagus nerve or through releasing cascades of chemicals in the gut which subsequently affect brain chemistry, it is becoming clearer that the bugs in our tummies are “talking” to the neurons in our heads (see the fantastic infographic on this page – and read the accompanying text for loads of the speculation on how this is working).
Those thoughts that you have are, after all, electrical impulses. We may populate those electrical impulses with contextual information from our historical and present experiences – but is our background thinking mode (happy/depressed/angry/anxious etc.) that way to begin with because the bugs we co-habit the planet with are firing off our neurological soup? We’ve all experienced feeling unnecessarily hyper-aware of our surroundings and anxious for no reason. Is it really us, or are our microbiota sending alarm bells that have nothing to do with where we are and/or who we’re with?
This brings me back to my original point: we often tie our identity into our knowledge of how we think and feel. Are we basing our understanding of ourselves on the psychological states our gut bacteria push us into? If gut bacteria alter behavioural states, making us more impulsive or prone to fear, then are we who we think we are or are we thinking according to the microbiome’s chemistry? (And if these gut bacteria are really powerful enough to transform how we act, hadn’t we better be sure that our gut bugs are the healthiest they can be?)
Gluten and The Brain
Possibly leading the charge ahead of gut bacteria in the ‘zeitgeisty’ topics of modern healthcare is gluten. Being gluten intolerant started out as a revelation, then a cult, then dismissed as ‘fussy’ and then relegated into the realms of ‘we don’t know’ in modern society. From being socially weird and awkward, to socially acceptable and then to being socially frowned upon as an excuse to cover up an eating disorder, gluten intolerance may or may not be as rife or as damaging as some healthcare practitioners have made it out to be.
My stance on gluten is really quite simple: gluten is a very complex protein. No human can entirely break down gluten into the individual peptides required for total absorption within the digestive tract. Instead, it is just broken down into slightly smaller links of peptides which individuals can struggle with more than others. However, because it is never broken down fully, this does mean that the consumption of gluten will always pose a challenge to the digestive, bacterial and immune function of every human being.
But so does walking down the street.
Whether you are sensitive to gluten in such a way that it is damaging and undermines your health is determined by two major factors: genetics and/or how exposed you are to toxins in the rest of your daily life. The modern complications with gluten may have arisen because of this latter factor: toxicity is so widespread, from pollution to water to homeware and self care products, and even to the antibiotics and hormones in our meats/eggs/milk/cereal grains etc. However, gluten is an individualised issue and some people are just more undermined in their biology than others and therefore more sensitive to it or not.
But this blog is about the brain and our thinking – so what does gluten have to do with it?
Well, firstly, for those who are sensitive to gluten there are two issues. The first is inflammation – for which see a subsequent section “The Brain on Inflammation”. The second, more relevant to everyone whether intolerant or not, is addiction.
For two reasons, gluten (along with casein which closely resembles gluten as a protein) can be an addictive substance. To start with, when your body consumes something that you are intolerant to or have to struggle to metabolise there is a release of a cascade of chemicals which are actually a bit of a rush to the body. As someone who has previously suffered with histamine intolerance, I know that the buzz of energy given when riding the inflammatory cascade can resemble the endorphin rush you get after exercising. This has quite a powerful pull. In a completely tiny way, this could be happening with gluten – pulling you towards it and altering your behaviour to seek that reward response.
But it goes deeper than that. There is scientific evidence to suggest that certain proteins called exorphins and gliadorphins (from gluten and gliadin in wheat, respectively) could mimic the compound morphine in the brain, thereby proving an addictive substance. This paper here highlighted potential mechanisms for this.
But… my concerns with this is that this is practically the only paper on this topic. I’m pretty sure our bodies are intelligent enough to know whether it’s morphine or gluten exorphins that are floating around. And there is, as yet, no solid evidence to fully confirm that exorphins really do cross the blood-brain barrier. So why do I mention addiction at all?
Sugar and the Brain
I mention it because of sugar. Gluten is found in wheat – and so it is a carbohydrate. Whether or not the wheat you consume is bound up with sugar (and it so often is, even in breads) we do know that carbohydrate consumption is what allows sugar (or more specifically, glucose) into the bloodstream and around the body to all of our cells. The motivation towards and away from carbohydrate-containing foods often seems like behaviourally influenced. However, for two reasons this is actually a chemically driven process. So you might think you’re a no-good binger of breads and pastas, someone with no portion control and no self-censorship for food consumption. But the reality is that we are genetically programmed to make a beeline for those substances which are rich in calories and easy to digest. We are still primates, really – used to a time when food was hard to obtain. Now it’s easy but we’re still driven to hoard ‘just in case’ of an impending famine.
So who you think you are when it comes to the pull of food behaviours and self-regulation may be entirely linked to far more primitive biological drivers which are determining your behaviour.
And taking this beyond the carbohydrate/glucose argument and onto simple sugars: sugar is definitely as addictive as hardcore drugs. Sugar really does cause the release of dopamine (the reward/pleasure chemical) in areas of the brain that are linked to addictions, in particular the nucleus accumbens. Whether it is sugar, flour, a combination of the two – or a combination of eating sugar alongside something that causes an inflammatory cascade, it is clear that food can become addictive because of the power it has to influence the chemical milieu in your brain.
Addicts: Personality or Brain Chemistry?
Now, as someone who works with clients regularly on the psychology of food, I know that when you crave something desperately it forms part of who you think you are. Our terminology doesn’t discriminate between psychiatrically- or biologically-driven cravings. You’re just “an addict”. If you feel the alluring pull of pasta, cakes, bread slathered with butter, cookies etc. you think of yourself as an addict, lacking in willpower. You draw assumptions about your personality and ‘self’ based on the sensations of irresistibility that arise out of your body in response to your drug of choice. And just a small part of you hates yourself for being out of control.
But are you that “addict”, or is your body being subliminally medicated against your will by nutritional ingredient that resembles a narcotic? Is your brain craving the release of dopamine from sugar, rather than you, as a human being, being a ‘sugar addict’? Is the attraction to the sensation of eating that wheat or sugar more about the mental high – and if so, is that a reflection of your humanity or your character? Not really. It is a reflection of chemistry.
When we see our desires and cravings as reflections of ourselves we develop a self-judgement, a self-criticism and an internal monologue of self-hatred. We neglect to acknowledge that we are biological animals running on chemical messengers. We are not addicts, but our bodies can be addicted. This should change this internal monologue and alter our understanding of what drives the behaviours we most judge in ourselves. And in so doing – surely we can change the behaviour by manipulating the diet to nurture, rather than stimulate, our synapses?
As an aside: Can this be fully extrapolated onto all addictions? Yes, it can. There is a lot of evidence to suggest that addiction is highly chemical, as all addicitons are either to chemicals, or release chemicals in their enactment. These are therefore biological in nature, and as such there are nutritional and lifestyle alterations which can have profound effects on the addiction and the addict. Does this completely negate psychological therapy? No – because sensations of emptiness, lack of love and other psychological and emotional drivers can push us more towards requiring that chemical release/stimulus of dopamine etc. than would otherwise be natural. As always, both biology and psychology must be addressed to provide complete therapeutic assistance.
Anxiety and Sugar
Sugar has another role to play in changing our brain chemistry. Our body runs on glucose (and/or possibly ketones, but I’ll save that argument for another time!). If we have massively fluctuating levels of glucose in our blood stream, there is a natural physiological and mental response: anxiety. Please be aware that I am not saying sugar causes anxiety. I am saying that the body’s physiological responses to sugar (and the rapid drops resulting in a lack of it) are physiologically identical to the experience of anxiety or stress: cortisol spikes and crashes, adrenaline surges etc.
Perhaps the most extreme of these states is not the rush of sugar highs, but the fog and confusion of sugar lows. Hypoglycaemia is a physiological state which makes people snappy, irate, angry and terse. The word “hangry” was invented for this reason: it is quite common to have shorter emotional fuses when the glucose supply is running low and the body is starting to send out alarm signals that more food is required. We are not angry people, but this lack of energetic reserve creates less patience – yet another situation where the result of nutritional and biological status literally alters our behaviour and personality.
It seems that life is littered with both obvious – and less obvious – examples of how brains are physical organs and are therefore driven by physiological states. So we are doing ourselves a great disservice by assuming we are how we think and feel.
The Brain on Inflammation
But there is a more subtle biological state which can dramatically alter our personality and our thoughts. This is more challenging, because often the physical ’cause’ is less obvious. This state is ‘inflammation’.
Inflammation is now commonly regarded as the root of many, if not all, illnesses. It is most certainly a component in every single state of physical ill health or disease.
And yet inflammation is not solely bad: it is, instead, both the preserver and the remover of life. It helps us survive and kills us. Inflammation is the archetypal double-edged sword. As such, necessary inflammation must be maintained whilst excess inflammation must be minimised. Keeping this balance is probably the biggest key to longevity.
But what about the brain? What happens in the brain in a state of inflammation? And what causes neuroinflammation?
This could form an entire book, let alone a single blog post.
One of the biggest causes of neuroinflammation is systemic inflammation – simply because, as I keep reiterating, the brain is part of the body. To imagine that it would be immune from something causing an inflammatory reactivity elsewhere is nonsense. One of the biggest causes for immune activity and systemic inflammation is intestinal permeability. Again, I almost hesitate to say this because conventional science still seems to ridicule it even though countless studies (see a review paper here) validate the fact that the intestinal barrier is both vital to health function and can be broken down by various factors.
This landmark study was a turning point within the understanding of how gluten, mentioned above, could directly alter gut function and inflammation throughout the body. It also highlights in beautiful detail how the digestive tract is fundamental to systemic inflammation and henceforth neuroinflammation. The reason the gut barrier and the blood-brain barrier are affected by the same things is because they are fundamentally similar. In fact, whilst they protect different tissue, they maintain barrier function and organ homeostasis in very much the same way. Therefore it has been shown that what affects one affects the other.
But what does neuroinflammation give rise to? It has been shown to cause neurodegeneration (more later), brain fog, Multiple Sclerosis, fatigue – including Chronic Fatigue and also mental conditions such as schizophrenia and bipolar disorder.
This is where inflammation, systemic inflammation and hence neuroinflammation affects personality and behavioural disorders. As we review the research on neuroinflammation giving rise to psychiatric disorders it becomes clear that there is a massive physical involvement in the function of, and therefore the thoughts inside, the brain. These motivate both behaviours but also a sense of self. We describe such psychiatric disorders as personality disorders, or behavioural disorders. But that is clearly far too simplistic. Again, these terms imply some failing of character and personality, rather than relating the full story which is that physiological conditions can give rise to a chemical and functional state of the brain which dramatically alters behaviour, thoughts, feelings and, bluntly, sanity.
But this doesn’t just hold true for extreme psychiatric illness. This paper focuses on depression – a fairly common condition we assume is a personality trait or situation founded on emotions, life experiences or situations. We refer to people as ‘being depressed’ – implying that they are depressive by nature, rather than by biological events. And yet the paper referenced above conclusively identifies the many sources of physical inflammation which contribute to the mental state which is referred to as depression. Again, our body is inflamed and the result is a mental state which we mistakenly assume is a reflection of our character rather than a symptom of internal dysfunction. As if by way of confirming this fact, this paper shows how anti-depressants have an anti-inflammatory effect – and therefore their action to help with depression may be more due to their effect on systemic (and therefore neurological) inflammation rather than on neurotransmitters.
So who are you if you’re only the person you think you are because your body is suffering from low-grade inflammation? Are you really all the things you judge yourself for? Is there really any need to be so critical of your personality and your moods, your predominant emotional outlook on life? Can you resent yourself for your emotionality or your bitterness, your bleak mental outlook or your inability to ‘pull yourself together’?
Surely, given that what effects that mental and emotional ‘default’ is so clearly rooted in our physiological reality, if we change the body we will change the mind – and therefore completely change the way you think about who you and how you relate to the world?
Forgetting Who You Are
I have written a whole blog post on neurodegeneration and nutrition which highlights the links between neurodegenerative diseases and the so-called Standard American Diet. I therefore won’t go into the biochemical details here. But I do want to make the point that there are a couple of people in my life at the moment who are talking about themselves as if they are dozy, stupid and falling to pieces.
Of course, they are none of those things, because as I have established many times above, their mental state doesn’t actually indicate who they are as people. They are merely forgetting things – and this is a biological and inflammatory situation rather than a reflection of their personality.
Here is where the above information turns a little on its head. Rather than our brain chemistry defining what we think of ourselves, here is where our brain chemistry takes away our sense of who we are as it takes away our memories. We only know who we are when we can put ourselves in the context of our relationship to things in our life. We trace our identity in our memories and our relationship to those around us. Neurodegeneration is a process which actually erodes the very essence of who we thought we were.
But here is where viewing the psyche as a reflection of biology is perhaps most obvious. Just because you can’t remember your storyline, does it change who you are or who you were? The answer is no. The sufferer of dementia loses themself to the biological neurodegeneration that occurs in the brain. It is not the person who changes, but the health of the brain changes the relationship to the self. If you believe this is just a personality ‘ageing’, I do encourage you to read my previous post. Because here again, in this most vulnerable of brain states, we can see that our biology is driving this process, and this biology deterioration is driven by the nutritional and physiological elements of our life.
Which all leads me onto conclusions – and thank you if you stuck with me thus far.
My point of writing all of this is to encourage you to think about yourself differently. I want you to embrace every thought, feeling and emotion that you have as a part of who you are as a whole human being: which includes what’s happening in your body.
This means that sometimes the parts of ourselves we are struggling with or are critical of actually emerge out of our biology. And what does all of this say for interventions? Can we play with the microbiome and change behaviour? Can we change our diet and change our thoughts, or at least our capacity to think? Can we decrease inflammation and suddenly see more clearly? Will we change ourselves by changing how we eat? Can we change who we think we are by changing our biochemistry?
My answer to all of these questions, from my research but also from seeing how I change profoundly when I eat certain foods or in a certain way, is yes.
And whilst I could go on and on for hours about the unpredictability of all of these tweaks and manipulations, the truth is that how your brain works is dependent on the environment around and inside you. What you eat and how you are nourished directly effects that. If you are currently dealing with a psychiatric, psychological, emotional, mental, feeling issue – there may definitely be work to do that would normally fall under the psychotherapeutic and counselling umbrellas. But I strongly doubt that it only requires psychological or psychiatric tweaking.
Please give yourself the best, best chance of healing – but also of really having the right idea about who you are as a person and your natural ways of behaving – by looking after your biology, your bacteria and your body. As I said to begin this post – there is nothing more important to the way you live and experience your life than your sense of who you are. You absolutely deserve to have the right idea of yourself – and that means lining up biology and behaving as if your personality is a reflection of the overall effective functioning of all of your entire being.