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13 Chapter 1: Collection of Papers Overview Joe Nelson College of Social

13

Chapter 1: Collection of Papers Overview

Joe Nelson

College of Social Work, University of Kentucky

SW 894-201: Colloquium II

Dr. Katrinna Matthews, DSW, LAPSW

February 25th , 2024

Chapter 1: Collection of Papers Overview

Introduction to Collection of Papers

Mental health conditions, including depression, anxiety, schizophrenia, and severe bipolar have become prevalent to the extent of attracting international attention (Faraj et al., 2021). Despite the trend in mental health, researchers and practitioners have made great strides in managing the conditions through research linking nutrition, gut health, and overall health. The studies have discovered that diet and gut health are primary determinants of mental well-being rather than secondary. This discovery sheds light on better management of mental illnesses through a biological approach, which would control diet as one of the risk factors. Previously, pharmacology and psychological approaches have helped treat and manage mental conditions such as schizophrenia. However, the findings about nutrition, gut, and mental well-being provide a different intervention where an appropriate diet can help prevent mental conditions. For example, studies show that people eating a Mediterranean diet, which has more whole grains, fruits, and vegetables, have lower depression rates than those eating a Western diet (Dinan et al., 2015). The research demonstrates possible gains for psychiatry and social work to incorporate intestinal health and dietary patterns to control and prevent mental illness.

However, limited empirical studies on the mechanism of gut and brain communication exist as evidence of the link between nutrition, gut health, and mental well-being. The research area is relatively new, and the lack of a conceptual framework with evidence around the gut-brain axis blocks the development of a practical dietary intervention for preventing and managing mental conditions. Thus, this overview of the collection of papers intended to recognize literature and evidence on the influence of nutritional factors and gut health on mental well-being and propose a clinical nutrition program and workshop for equipping people with knowledge on how to manage their nutrition towards prevention and control of mental conditions.

This collection comprises three papers to achieve the purpose: The systematic review will answer the overall research question: How do nutritional factors and gut health influence mental well-being, and what evidence can corroborate this link around the Gut-Brain Axis? Next, the conceptual paper conceptualizes the link between diet microbes and mental conditions within the gut-brain axis. Finally, the practice application paper will explore the implementation of the evidence through clinical nutrition program workshops describing the benefits of diet in mental health.

Systematic Literature Review Overview

Studies on the contribution of microbiota in numerous physiological processes that contribute to neurotransmitter production, compromised metabolism, and immune system regulation have been ongoing (Fassarella et al., 2020). Studies have also shown that a nutrient-rich diet contributes to beneficial and healthy gut microbiota (Horn et al., 2022). As a result, researchers and practitioners have been relating a nutrient-rich diet with gut microbiota and neurotransmitter production, immune system regulation, and compromised metabolism. However, the research has progressed with attention to how nutrition and gut microbiota affect mental well-being, aiming to develop microbiome target therapy (MTT) and nutrition programs to prevent and manage mental health conditions. The mechanism of the relationship between the gut and brain through gut microbiota remains unknown. Following the development, the systematic literature review in this collection of papers gathered information from current research to answer the prompt: How do nutritional factors and gut health influence mental well-being, and what evidence can corroborate this link around the Gut-Brain Axis?

Outcomes from the systematic review showed a relationship between anxiety and depression with nutrition. The studies identify the impact of diet and the condition of the gut microbiome on depressive reactions (Tan et al., 2022; Scepanovic et al., 2019; Uddin et al., 2017). Research is further specific on particular roles of specific nutrients in mental state and well-being. At least half of the reviewed studies report evidence over the years about the contribution of omega-3 fatty acids to depression treatment (Mochimasu et al., 2016). Moreover, experiments have shown that a diet with low omega-3 significantly impacts neuronal function disturbances (Silva et al., 2020). However, researchers call for narrow studies on the association to determine specific nutrition components and dosage (Limbana et al., 2020; Horn et al., 2022).

Additionally, literature associates a Western diet rich in fats and sugars with depression. Similarly, findings showed that a Mediterranean diet with high fiber and prebiotics is likely to lower depression pathology (Altomare et al., 2017). Research has further established an association between the onset of anxiety and depression and changes in gut microbes, including deceased Lachnospiracea, Bifidobacterium, and Lactobacillus (Góralczyk-Bińkowska et al., 2022). Apart from the connection between nutrition, gut, and depression, the literature has established that probiotics influence the communication network in the gut-brain axis (Tan et al., 2022). Clinical tails report changes in biochemical parameters such as decreased enzymes and metabolites, decreased levels of proinflammatory cytokines with consumption of vegetables and fruits, and reduced free sugars and saturated fats (Tan et al., 2022). The clinical trials provide evidence about the gut-brain axis. Thus, the literature review concluded by responding to the research question as part of the solutions to mental conditions, showing the influence of nutrition and the gut on mental well-being.

Conceptual Paper Overview

The conceptual paper takes from the systematic review by providing a framework of evidence on the impact of nutrition and gut health on mental health. Despite the reviewed literature surrounding the gut-brain axis and its effects on mental well-being, there is no theoretical underpinning of specific diets to particular mental health issues that would guide the implementation of microbiome target therapy and nutrition interventions. Researchers such as Chakrabarti et al. (2022) have highlighted the value of nutrition in maintaining mental health, but there is no evidence of the gut-brain axis system. The lack of an established gut-brain axis mechanism blocks the development of models that can guide practitioners and social workers toward designing nutrition-targeted programs to promote mental health, including prevention and management. The inadequate knowledge of the influence of gut health on mental conditions leads to reliance on pharmacotherapy and psychological therapies (Turner et al., 2015). As a result, the practitioners overlook the biological aspect of mental health that would improve the effectiveness of the interventions. The biological approach to mental health through the gut health approach would be a preventive approach to address underlying causes and save society from the burden related to disease (Creed, 2022). Therefore, the conceptual paper aimed to address the evidence of the interaction between dietary patterns, gut health, and psychological well-being. The conceptual framework for this collection of papers includes concepts and theories that inform the relationship between nutrition, nutritional patterns, gut health, and mental well-being.

Concepts that inform the conceptual framework come from diet, gut, and mental health studies. In depression, Rhodes (2020) observed that probiotics can promote intestinal equilibrium involved in central nervous system (CNS) related processes. Still, Tait and Sayuk (2021) showed communication by some neurological, hormonal, and immune systems with intestinal microflora in gastrointestinal illnesses. Tan et al. (2022) further demonstrated the effect of the vagus nerve on the signaling path between the gut and the brain, leading to inflammation and vagal tone in depression. Research has also established the contribution of particular foods in the gut-brain interaction leading to mental health. A carbohydrate and high-fat diet promotes pathogenic bacteria, leading to inflammation and brain oxidative stress. High folate (vitamin B12) levels can lower depressive symptoms (Khosravi et al., 2019). These studies show the connection between diet, gut, and brain through microorganisms and hormonal systems.

The conceptual paper also drew from the bio-psychosocial model and gut-brain axis theory to relate nutrition, gut health, and mental health. The bio-psychosocial model links psychological, biological, and social elements to connect mental and gut health (Rucklidge et al., 2021). Although the model focuses more on physical health, it helps to understand health beyond biological perspectives. Following the bio-psychosocial model, health results from various factors that interact to create risks and conditions. The framework considers psychological and social aspects, including diet, significant in determining body well-being. For example, following the model, the psychological component includes feed aspects where eating habits result from nutritional choices and contribute to mental health (Syed et al., 2020). On the other hand, the gut-brain axis theory is more specific and explores brain-gut communication and the communication system. The literature demonstrates that the gut flora, immune system, and hormonal pathways have intricate roles (Appleton, 2018). The gut microorganisms facilitate communication with the brain (Zagórska et al., 2020). Research has further revealed that microbial substances can trigger neuro-inflammation related to some mental conditions, such as stress and depression (Abhari & Hosseini, 2018).

Practice Application Paper Overview

The practice application paper builds on the conceptual paper by describing the solution to mental health. Following the systematic review, the proposed solution is to employ diet and gut health in preventing and managing mental health issues. The solution will be implemented through a training manual for social workers and clinicians to equip them with knowledge on applying nutrition and gut health to manage mental conditions. Social workers experience limitations in their training, especially within nutrition and gut biome, which could be helpful in biological intervention to address mental health. One Australian study showed that only 38% of people consume enough water, 58% consume sugary drinks, and 75% consume fast foods (Mawer et al., 2022). The statistics imply that social workers have not been impactful in influencing diets that can help the community manage mental health. The practice application paper bridges that gap in knowledge by using literature on evidence about the influence of nutritional factors and gut biome on mental health to inform a manual for training on the benefits of diet and specific nutrition interventions.

Moreover, the practice application paper expands from the systematic literature review and conceptual framework to bridge a practice gap in managing mental health. The paper explains the missing avoidance strategies in mental health where individuals could be selective in their diet towards mental health, such as avoidance of depression or management of symptoms. Evidence from regional case studies on specific nutrition, such as vegetables and omega-3 acids, informed the development of clinical nutritional programs and workshops on the benefits of particular diets. Integration of the evidence and regional case studies helped overcome the limited confirmation of the influence of specific dietary diets on gut health and mental well-being (Ribeiro et al., 2022). Moreover, the practice presented the microbiome targeted therapy (MTT) aimed at developing the right gut microbiome to promote mental health (Ribeiro et al., 2022). The MTT development followed evidence on dietary interventions for nutritional effectiveness in developing neuroactive microbiota. Overall, the practice paper culminates the systematic literature review by using the evidence to establish a solution for mental well-being.

The outcome of the practice paper is a 9-hour curriculum training for social workers and clinicians, including psychiatrists and nutritionists, to introduce the basic concepts of managing mental health using nutrition and gut health. In other words, the social workers and clinicians will be trained to treat and prevent mental illnesses using nutrition and gut health. The gut-brain axis theory and bio-psychosocial model will guide and be part of the training content. Both theories aim to enlighten and expose social workers and clinicians to the value of changing dietary patterns on gut health and mental well-being. Researchers have found the bio-psychosocial model effective in addressing various health issues, including mental well-being (Syed et al., 2017). The social workers and clinicians will also learn how the model informs and its application in guiding dietary intervention plans for mental health. Another topic to cover in the training is the link between nutrition, gut health, and mental well-being. Although this course will be short and cover the general concept of diet-gut-mental health relationships, social workers and clinicians will be expected to develop the foundational knowledge to use in evidence-based practice to help communities address mental health. The knowledge gained will aid clinicians and social workers in developing intervention plans for preventing or managing mental health conditions. For example, through knowledge, social workers can locate a culturally appropriate diet to improve a community’s mental health and influence the direction. The overall learning outcome of the 9-hour curriculum training is to use the gut-brain axis theory to develop an intervention plan for individuals and communities to prevent or manage mental health issues.

Key Findings

This collection of papers aimed to provide evidence on the influence of nutritional factors and gut health on mental well-being and develop a practice guide for clinical training programs to prepare them for dietary intervention approaches for mental health. One key finding from the literature is the impact of nutrition and the gut on mental health through gut-brain communication. The literature has provided evidence on the contribution of gut health following nutrition to mental health. Evidence has also shown the mechanism of the gut on mental health through microorganisms and the management of the immune system and free radicals (Fassarella et al., 2019). Another key finding from the literature is increased consumption of a diet that risks mental health, such as sugar and lack of vegetables (Mawer et al., 2022). The finding led to another that social workers and clinicians lack knowledge and practice manuals to guide people and communities towards healthy nutrition for mental health. Finally, the collection of papers informed about specific diets promoting mental health, including the Mediterranean diet, with plenty of whole grains and vegetables (Dinan et al., 2015). The findings informed a solution for high-prevalence mental conditions by developing a clinical nutrition program using the brain axis theory and bio-psychosocial model.

References

Abhari, K., & Hosseini, H. (2018). Psychobiotics: Next-generation treatment for mental disorders. Journal of Clinical Nutrition. Diet, 4(1), 1-7. https://doi.org/10.4172/2472-1921.100063.

Altomare, R., Damiano, G., Palumbo, V., Buscemi, S., Sipinelli, G., Cacciabaudo, F., Monte, G. Maffongeli, A., Fazzotta, S., Gulotta, E., Gulotta, L., Altomare, S., Maione, C. & Monte, A. (2017). Feeding the brain: The importance of nutrients for brain functions and health. Progress in Nutrition, 19(1): 243-247. https://doi.org/10.23751/pn.v19i3.4821.

Appleton, J. (2018). The gut-brain axis: Influence of microbiota on mood and mental health. Integrative Medicine: A Clinician’s Journal, 17(4), 28-33. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469458/pdf/imcj-17-28.pdf.

Chakrabarti, R., Fung, T. S., Kang, T., Elonkirjo, P. W., Suomalainen, A., Usherwood, E. J., & Higgs, H. N. (2022). Mitochondrial dysfunction triggers actin polymerization necessary for rapid glycolytic activation. Journal of Cell Biology, 221(11), 1-9. https://doi.org/10.1083/jcb.202201160

Creed, F. (2022). Risk factors for self-reported irritable bowel syndrome with prior psychiatric disorder: The lifelines cohort study. Journal of Neurogastroenterology and Motility, 28(3), 442-453. https://doi.org/10.5056/jnm21041.

Faraj, S., Renno, W., & Bhardwaj, A. (2021). Unto the breach: What the COVID-19 pandemic exposes about digitalization. Information and Organization, 31(1), 100337-1003346. https://doi.org/10.1016/j.infoandorg.2021.100337.

Fassarella, M., Blaak, E. E., Penders, J., Nauta, A., Smidt, H., & Zoetendal, E. G. (2020). Gut microbiome stability and resilience: Elucidating the response to perturbations to modulate gut health. Gut, 70(3): 595-605. https://doi.org/10.1136/gutjnl-2020-321747.

Góralczyk-Bińkowska, A., Szmajda-Krygier, D., & Kozłowska, E. (2022). The microbiota–gut–Brain Axis in psychiatric disorders. International Journal of Molecular Sciences, 23(19): 11245-11253. https://doi.org/10.3390/ijms231911245

Horn, J., Mayer, D. E., Chen, S., & Mayer, E. A. (2022). Role of diet and its effects on the gut microbiome in the pathophysiology of mental disorders. Translational Psychiatry, 12(1), 1-13. https://doi.org/10.1038/s41398-022-01922-0

Khosravi, M., Sotoudeh, G., Amini, M., Raisi, F., Mansoori, A., & Hosseinzadeh, M. (2020). The relationship between dietary patterns and depression mediated by serum levels of Folate and vitamin B12. BMC Psychiatry, 20, 1-8. https://doi.org/10.21203/rs.2.12079/v1.

Limbana, T., Khan, F., & Eskander, N. (2020). Gut microbiome and depression: how microbes affect the way we think. Cureus, 12(8), 1-10. https://doi.org/10.7759/cureus.9966.

Mawer, T., Kent, K., Williams, A. D., McGowan, C. J., Murray, S., Bird, M.-L., Hardcastle, S., & Bridgman, H. (2022). The knowledge, barriers, and opportunities to improve nutrition and physical activity amongst young people attending an Australian Youth Mental Health Service: A mixed-methods study. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-08182-0.

Mochimasu, K., Miyatake, N., & Hase, A. (2016). A pilot study of the relationship between diet and mental health in female university students enrolled in a training course for registered dietitians. Environ Health Prev Med, 21 (5): 345-349. https://doi.org/10.1007/s12199-016-0535-1.

Rhodes, J. M. (2020). Nutrition and gut health: The impact of specific dietary components – it’s not just five-a-day. Proceedings of the Nutrition Society, 80(1), 9-18. https://doi.org/10.1017/s0029665120000026.

Ribeiro, G., Ferri, A., Clarke, G., & Cryan, J. F. (2022). Diet and the microbiota–gut–brain-axis: A Primer for Clinical Nutrition. Current Opinion in Clinical Nutrition & Metabolic Care, 25(6), 1-9. https://doi.org/10.1097/mco.0000000000000874.

Rucklidge, J. J., Johnstone, J. M., & Kaplan, B. J. (2021). Nutrition provides the essential foundation for optimizing mental health. Evidence-Based Practice in Child and Adolescent Mental Health, 6(1), 131–154. https://doi.org/10.1080/23794925.2021.1875342.

Scepanovic, P, Hodel F, Mondot S, Partula V, Byrd A, & Hammer C. (2019). A comprehensive assessment of demographic, environmental, and host genetic associations with gut microbiome diversity in healthy individuals. Microbiome, 7(1), 1-15. https://doi.org/10.1186/s40168-019-0747-x.

Silva, Y., Bernardi, A., Frozza, R. L. (2020). The Role of Short-Chain Fatty Acids From Gut Microbiota in Gut-Brain Communication. Front Endocrinol, 11. https://doi.org/10.3389/fendo.2020.00025.

Syed, S., Syed, S., & Bhardwaj, K. (2020). The role of the bio-psychosocial model in public health. The Journal of Medical Research, 6(5), 252-254. https://doi.org/10.31254/jmr.2020.6517.

Tait, C., & Sayuk, G. S. (2021). The brain-gut-Microbiotal Axis: A framework for understanding functional GI illness and their therapeutic interventions. European Journal of Internal Medicine, 84, 1-9. https://doi.org/10.1016/j.ejim.2020.12.023.

Tan, C., Yan, Q., Ma, Y., Fang, J., & Yang, Y. (2022). Recognizing the role of the vagus nerve in depression from microbiota-gut-brain axis. Frontiers in Neurology, 13, 1-15. https://doi.org/10.3389/fneur.2022.1015175.

Turner, J., Hayward, R., Angel, K., Fulford, B., Hall, J., Millard, C., & Thomson, M. (2015). The history of mental health services in modern England: Practitioner memories and the direction of future research. Medical History, 59(4), 599-624. https://doi.org/10.1017/mdh.2015.48.

Uddin, M. S., Al Mamun, A., Kabir, M. T., Nasrullah, M., Wahid, F., Begum, M. M., Labu, Z. K., Rahman, M. S., Islam, M. T., Amran, M. S., & Abdel-Daim, M. M. (2017). Neurochemistry of Neurochemicals: Messengers of brain functions. Journal of Intellectual Disability – Diagnosis and Treatment, 5(4): 137-151. https://doi.org/10.6000/2292-2598.2017.05.04.6.

Zagórska, A., Marcinkowska, M., Jamrozik, M., Wiśniowska, B., & Paśko, P. (2020). From probiotics to psychobiotics – the gut-brain axis in psychiatric disorders. Beneficial Microbes, 11(8), 717-732. https://doi.org/10.3920/bm2020.0063.

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