Running head: BIDIRECTIONAL RELATIONSHIP 1 The ... · professional’s understanding of how...

Running head: BIDIRECTIONAL RELATIONSHIP 1

The Bidirectional Relationship: Mental Health and Nutrition

A Literature Review

Presented to

The Faculty of the Adler Graduate School

_____________________

In Partial Fulfillment of the Requirements for

The Degree of Master of Arts in

Adlerian Counseling and Psychotherapy

_____________________

By

Stephanie M. Johnson

_____________________

Chair: Rachelle Reinisch, DMFT

Reader: Richard Close, DMin

____________________________

August, 2017

BIDIRECTIONAL RELATIONSHIP

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Abstract

Lifestyle modifications, such as eating a nutritious and balanced diet, promote a healthy gut

microbiota. A healthy gut microbiota balances the gut-brain axis, thus reducing anxiety and

reducing, or eliminating, the dependence on pharmaceuticals. The purpose of this project is to

provide education for mental health practitioners regarding the gut-brain axis research in an

effort to bring awareness to the bidirectional relationship between mental health and nutrition.

Gathering nutritional information during a lifestyle assessment can assist practitioners in the

development of a holistic approach to understanding clients.

Keywords: anxiety, mental health, nutrition, brain health, Adlerian therapy, gut-brain axis


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Acknowledgements

There have been many wonderful and amazing family, friends, and supervisors that

encouraged me along the way as I worked toward achieving a master’s degree. Of those people

were those who stood by me every step of the way, encouraging, celebrating, and helping me

through the past three years of this exciting journey. They were in the trenches with me through

this process and I could not have persevered without their support. My heart is full having you

in my life, and I will forever be grateful. Also, I would like to thank Jana Goodermont, LMFT

for my inspiration and my committee members, Dr. Rachelle Reinisch and Dr. Richard Close, for

their hard work and dedication to making this dream come true.


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Dedication

I would like to dedicate this paper to several important people that made a significant and

lasting impact on my life. They believed in me, cheered me on, supported me, and filled my life

with so much love. Their profound influence shaped much of who I am today. First, my father,

Bill Johnson, a true adventurer who also lived life to the fullest and taught me so many valuable

life lessons. He instilled in me the importance of going after your dreams, full force, head on,

without compromise and he supported me every step of the way. Second, my paternal

grandfather, Robert (Bob) Johnson, a big teddy bear with a huge, loving, and caring heart who

celebrated life to the fullest. Third, my maternal grandmother, Theresa Lepisto, a faith-filled,

loving, compassionate, selfless woman who brought so much richness and depth to my life.

Next, my grandfather Woodie Hendrix, who was sweet, kind, and wonderful. He loved life and

especially loved his family – he was one-of-a-kind. Lastly, having faith in Jesus Christ is not

always an easy road but one worth traveling, as He is the ultimate source of encouragement,

strength, support, and love.


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Copyright © 2017

Stephanie M. Johnson

All rights reserved


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Table of Contents

Mental Health.................................................................................................................................. 9

Stigmas ........................................................................................................................................ 9

Comorbidity .............................................................................................................................. 10

Health Decline .......................................................................................................................... 10

Anxiety .......................................................................................................................................... 11

Anxiety Disorders ..................................................................................................................... 11

Generalized Anxiety Disorder .................................................................................................. 12

Anxiety Treatments ....................................................................................................................... 13

Pharmaceuticals ........................................................................................................................ 13

Holistic Remedies ..................................................................................................................... 14

Relaxation and meditative techniques. ................................................................................. 14

Spirituality and religion. ....................................................................................................... 14

Sleep. ..................................................................................................................................... 15

Psychotherapy ........................................................................................................................... 15

Individual Psychology .................................................................................................................. 16

Movement ................................................................................................................................. 17

Self-Concept ............................................................................................................................. 17

Style of Life .............................................................................................................................. 18

Organ Inferiority ....................................................................................................................... 18

Organ Dialect ............................................................................................................................ 19

Compensation ........................................................................................................................... 19

Social Interest............................................................................................................................ 19

Individual Psychology and Mental Health .................................................................................... 20

Family of Origin ....................................................................................................................... 21

The Neglected Child ................................................................................................................. 21

Epigenetics ................................................................................................................................ 22

Nutrition and Mental Health ......................................................................................................... 22

Eating Habits ............................................................................................................................. 23

Foods ......................................................................................................................................... 25

Food is Medicine....................................................................................................................... 26

Time .......................................................................................................................................... 28

Supplements .............................................................................................................................. 28


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Gut Health ..................................................................................................................................... 28

The Gut ..................................................................................................................................... 30

Microbiota ................................................................................................................................. 30

Birth .......................................................................................................................................... 31

Leaky Gut.................................................................................................................................. 33

Prebiotics................................................................................................................................... 34

Probiotics .................................................................................................................................. 34

Brain Health .................................................................................................................................. 35

Environmental Influences ............................................................................................................. 37

Early Life Adverse Events ........................................................................................................ 37

Role of the Mother .................................................................................................................... 38

Rat study. .............................................................................................................................. 38

Human study ......................................................................................................................... 38

Stress ......................................................................................................................................... 38

Activation of Stress ................................................................................................................... 39

Action Steps .................................................................................................................................. 40

Interventions ............................................................................................................................. 40

Changing Habits........................................................................................................................ 41

Exercise, Sleep, and Water ....................................................................................................... 42

Exercise ................................................................................................................................. 42

Sleep. ..................................................................................................................................... 42

Water ..................................................................................................................................... 42

Nutrition .................................................................................................................................... 42

Program Supports...................................................................................................................... 43

Discussion ..................................................................................................................................... 44

Implications for Practice ........................................................................................................... 44

Recommendations for Future Research .................................................................................... 46

References ..................................................................................................................................... 48


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“The part can never be well unless the whole is well”

--Plato

The information provided in this review will offer insight to marriage and family

therapists regarding the research on how gut microbiota health has an impact on mental health

and how this information influences the mental health profession. Understanding this

information is important because research shows physical and mental health are directly

correlated to one another. The purpose of this project is to increase the mental health

professional’s understanding of how lifestyle modifications, specifically eating a nutritious and

balanced diet, can promote a healthy gut microbiota, thus, reducing anxiety and reducing, or

eliminating, the dependence on pharmaceuticals.

Lifestyle modifications, like choosing a healthy diet, exercise, and low alcohol intake,

may reduce a person’s depression or anxiety (Berk, Sarris, Coulson, & Jacka, 2013; Mayer,

2016). Clarke, O’Mahony, Dinan and Cryan (2014) reported that the type of food people eat at

the onset of life has a profound effect on mental health outcomes. In fact, there is a correlation

between anxiety and inflammation within the body (Mayer, 2016; Mizrahi et al. 2012; Moons &

Shields, 2015). In addition, there is a direct association between depression and inflammatory

responses within the body (Maes et al., 2013). Despite this knowledge, an increasing number of

people are becoming mentally and physically sick (Richards & Sindelar, 2013). If mental health

professionals are to successfully treat individuals struggling from anxiety or any type of mood

disorder, they will need to take a holistic approach in reviewing client symptoms and get to the

root cause of the issue (Trindade & Murphy, 2015).


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Mental Health

Perlmutter and Loberg (2015) reported that in the United States, approximately one in

four adults suffer from a diagnosable mental disorder. Crocetti et al. (2015) reported 20% of

adolescents worldwide experienced some type of mental health disorder. Of these mental

disorders, mood and anxiety disorders are the most common, with mood disorders at

unprecedented highs (Perlmutter & Loberg, 2015; Trindade & Murphy, 2015). Trindade and

Murphy (2015) reported that depression is the leading cause of disability worldwide, affecting

one in ten people. In addition, Perlmutter and Loberg (2015) reported anxiety affected more than

40 million Americans. Consequently, 10% of the adult population in the United States utilized

medications, such as Prozac and Zoloft, to alleviate symptoms stemming from mental disorders.

Stigmas

Bathje and Pryor (2011) reported individuals do not want to be identified as a person with

a mental illness. Stigmas, or negative stereotypes, are attached to mental illness, despite the

prevalence and number of individuals that struggle with mental health issues (Sickel, Seacat, &

Nabors, 2014; Trindade & Murphy, 2015). For example, the most common stigmas are

associated with receiving a mental health diagnosis and seeking treatment through counseling

(Bathje & Pryor, 2011). These stigmas affect an individual’s basic human needs, such as self-

perception, employment, relationships, and physical health and influence whether he or she

would seek mental health treatment (Bathje & Pryor, 2011; Sickel et al., 2014). Sickel et al.

(2014) reported that due to these stigmas, many individuals delayed mental health treatment or

remained untreated. This lack of treatment led to an increase in the severity of the mental illness.


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Comorbidity

Tegethoff, Stalujanis, Belardi, and Meinlschmidt (2016) highlighted concerns

surrounding the comorbidity of mental health and physical health issues. Tegethoff et al.

reported that comorbidity had a direct impact on the health care system due to mental health

issues and physical diseases. Other concerns included a lower quality of life and higher

healthcare costs, both of which have a direct impact on an individual’s treatment response. Due

to these concerns, Tegethoff et al. stressed the importance of further research regarding the

comorbidity of mental and physical health issues, specifically in adolescents, and supported the

integration of mental and physical health care.

Sickel et al. (2014) reported that the annual financial costs associated with treating mental

illness in the United States is $57.5 to $300 billion dollars. The financial impact of these costs

on families and individuals with mental illness included loss in income or job security. In

addition, Sickel et al. reported that individuals with mental illness suffered higher mortality rates,

especially those who experienced co-morbid disorders.

Health Decline

Since the 1970’s, there has been an increase of health issues in the United States, such as

obesity, inflammatory bowel diseases, autism, and Alzheimer’s disease (Mayer, 2016). Mayer

reported the obesity rate has increased in the United States from 13% in 1972 to 35% in 2012.

Mayer concluded that if obesity continues to rise at this rate, the costs of treating this epidemic

will be an annual amount of $620 billion. In spite of the awareness of these health issues, limited

effective solutions exist to date (Mayer, 2016).


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Anxiety

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American

Psychiatric Association [APA], 2013) defined anxiety as the anticipation of a future threat,

vigilant preparation for future dangers, and the display of avoidant behaviors. Worldwide, 5.7%

of the adult population struggles with anxiety (APA, 2013; Crocetti, et al., 2015; Ross, Hood &

Short, 2016). In the United States, 18% of Americans with anxiety reported that everyday

chronic stress was the main contributor to increased levels of anxiety (Bongiorno, 2014;

Trindade & Murphy, 2015). Stress has a strong impact on the hypothalamic-pituitary-adrenal

(HPA) axis and the sympathetic nervous system, which has a negative impact on the organ

systems, ultimately creating adverse symptoms or anxiety (Bongiorno, 2012; Trindade &

Murphy, 2015).

Moons and Shields (2015) reported that anxiety can cause withdrawal behavior, which

prompts the immune system to protect itself. As a result, inflammation increases in the body.

Moons and Shields stated that inflammation is a form of protection (a preventative act) that

prepares the body to cope with potential injuries or infections. Additionally, Moons and Shields

pointed out that the act of the body protecting itself may influence withdrawal behaviors in the

individual. Consequently, an individual is in a cycle of anxiety, withdrawal, and inflammation,

which leads to increased withdrawal behaviors associated with anxiety.

Anxiety Disorders

Anxiety disorders are the most common mental health disorders within the general

population (APA, 2013; Harrington, 2016; Meng & D'Arcy, 2015). In the U.S., anxiety

disorders are one of the most prevalent group of disorders affecting more than 40 million

Americans (Perlmutter & Loberg, 2015). More specifically, anxiety disorders are among the


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most commonly diagnosed adolescent mental health disorders (Crocetti et al., 2015); however,

when children experience untreated anxiety, they have a higher likelihood that anxiety will

persist into adulthood (APA, 2013).

Anxiety disorders include the presence of intense, persistent, and excessive fear and

worry about everyday situations, which last six months or more (APA, 2013). Additionally,

there are 10 forms of anxiety disorders, all of which are categorized by the type of situation a

person avoids and the content of thoughts surrounding the situation. Anxiety disorders are

recognized as a major medical and societal issue (Bongiorno, 2014; Harrington, 2016; Perlmutter

& Loberg, 2015; Sickel et al., 2014). Harrington (2016) reported that uncontrolled anxiety could

shorten an individual’s lifespan. According to the DSM-5, cultural considerations, and the

underlying cause of the symptoms, must be considered prior to an anxiety diagnosis (APA,

2013).

Generalized Anxiety Disorder

According to the DSM-5, generalized anxiety disorder (GAD) is one of the most common

anxiety disorders and defined as excessive anxiety or worry about events or activities (APA,

2013). These worrisome thoughts are excessive, difficult to manage, pervasive, pronounced, and

distressing. Physical symptoms associated with GAD include being on edge, muscle tension,

tiredness, difficulty concentrating, and disturbed sleep (APA, 2013). Additionally, these

symptoms, along with the excessive worry, affect a person’s ability to perform at home and at

work. Crocetti et al. (2014) stated GAD is one of the most common anxiety disorders in

adolescents and is more prevalent with adolescent girls. Also, Crocetti et al. discovered that

adolescents diagnosed with GAD typically live with symptoms of GAD into adulthood. In the

U.S. alone, there are 110 million disability days per year attributed to GAD (APA, 2013).


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Anxiety Treatments

Perlmutter and Loberg (2015) reported that an individual can suffer with anxiety and

depression at the same time, as they are directly related to one another. For example, they both

induce negative thinking and they can cause the same type of physical symptoms, such as

headaches, pain, nausea, and gastrointestinal issues. Perlmutter and Loberg stated that

oftentimes individuals suffering from anxiety and depression are prescribed medications that can

help manage both disorders at the same time. Bongiorno (2012) stated that there are many forms

of treatments available for mood disorders, including conventional and unconventional

treatments.

Pharmaceuticals

Trindade and Murphy (2015) reported that pharmaceutical treatments are the typical

standard treatment response for individuals diagnosed with anxiety. Selective serotonin reuptake

inhibitors (SSRIs), introduced in the late 1980’s, are one of the most common pharmaceutical

treatments doctors prescribed to patients suffering from anxiety (Nielsen, Hansen, & Gotzsche,

2012; Trindade & Murphy). According to Harrington (2016), around 48 million Xanax

prescriptions (a benzodiazepine) had been prescribed to Americans. Trindade and Murphy

reported that pharmaceuticals may alleviate symptoms but they do not get to the root cause of

anxiety: an imbalance in an individual’s neurochemistry.

Pharmaceutical treatments focus on the neurotransmitters of the brain, provide temporary

relief, and can become addictive (Jerath, Crawford, Barnes, & Harden, 2015; Nielsen et al.,

2012). Pharmaceuticals are costly, partially effective, have substantial side effects, and can

create new chemical imbalances in the body (Harrington, 2016; Nielsen et al., 2012). Side

effects are common when using these medications, so practitioners will prescribe additional


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drugs to compensate for the additional side effects (Trindade & Murphy, 2015). Remission rates

for anxiety disorders are around 50% for those treated with pharmacotherapy or cognitive-

behavior therapy (Bar-Haim, 2010).

Holistic Remedies

Mizrahi et al. (2012) and Bongiorno (2014) stated holistic approaches, such as proper

nutrition, relaxation and meditative techniques, spirituality and religion, sleep, diet, supplements,

and botanicals, can be alternative forms of healing for some individuals struggling with anxiety.

However, Bongiorno (2014) reported that holistic remedies are not highly recognized by the

conventional medical world because holistic remedies lack scientific evidence.

Relaxation and meditative techniques. Mizrahi et al. (2012) suggested meditative

techniques, such as yoga, distract the active mind and increases the focus on images that induce

relaxation. Bongiorno (2012) reported there are health benefits of yoga in addition to the

relaxation and meditative benefits. First, yoga promotes deep breathing and proper blood flow.

Second, yoga can improve the relaxation response by reducing cortisol, stimulating the

production of endorphins, and increasing serotonin levels. Lastly, yoga promotes the cleansing

of toxins from the lymph nodes through muscle movement.

Bongiorno (2012) pointed out that there is a correlation between high cortisol levels and

depression, and since yoga reduces cortisol levels, yoga can be a form of an antidepressant.

Additionally, yoga induces an individual to enter into a meditative state, which if done for forty

minutes a day, can assist in the creation and growth of nerves in the brain (Bongiorno, 2012).

This meditative process can change the structure of the brain, slow or stop the aging of the brain.

Spirituality and religion. Bongiorno (2012) explained that an individual who engages in

some type of spirituality or religion enhances the favorable outcome of reducing a mood


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disorder. In fact, Bongiorno highlighted that 77% of patients discuss their spiritual needs with

their physician and 79% of patients believed that having a spiritual faith can help with recovery.

Furthermore, spirituality or religion can bring a sense of purpose and hope to an individual’s life,

creating a sense of meaning to life and a connection with others.

Sleep. Perlmutter and Loberg (2015) and Bongiorno (2012) explained that proper sleep

assists in the balance of hormones and fosters a healthy gut. Sleep also greatly influences mood,

so an individual should attempt to sleep around seven to eight hours every night (Bongiorno,

2012). In order to get the proper amount of sleep, Bongiorno suggested individuals should create

a bed time ritual. This ritual can consist of putting away all electronics a half hour before bed

and taking supplements such as melatonin, tryptophan, valerian, or motherwort.

Psychotherapy

Bongiorno (2012) defined psychotherapy as a tool used for individuals who are

experiencing life issues, such as, but not limited to, traumatic events, divorce, loss, relationship

conflicts, and feelings of isolation. Furthermore, the goal of psychotherapy is to help an

individual understand difficult life situations, process emotions, and cope with a difficult

situation. Bongiorno suggested an individual should work with a psychotherapist who has the

characteristics of a teacher, is willing to explain the process of psychotherapy, and can provide

tools and results throughout the process. Bitter (2009) stated there are various types of therapy,

including individual, couples, and family therapy, all of which provide different perspectives in

the therapeutic environment.

Individual Psychology, or Adlerian therapy, is one form of psychotherapy that is holistic

in nature, viewing all facets of the individual’s life (Carlson, Watts, & Maniacci, 2006). An

Adlerian therapist will focus on the therapeutic alliance, encouragement, and the client’s needs,


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rather than on specific therapeutic technique. Carlson et al. highlighted that one of the main

goals of an Adlerian therapist is to help individuals learn life skills through effective consultation

and educational services.

Individual Psychology

“To live means to develop. To live is like learning to swim. Do not be afraid to make mistakes,

because there is no other way to learn to live.”

--Alfred Adler

Powers and Griffith (2012) referred to Alfred Adler’s definition of Individual Psychology

as a “science for understanding of persons” (p. 7). Ansbacher and Ansbacher (1964a) described

Individual Psychology as how a person relates to life in various ways. Individual Psychology is

holistic in nature and assesses the entire individual’s movement in life (Powers & Griffith, 2012).

Powers and Griffith stated movement in life points to the individual’s idea of success. They

further described this movement in terms of how someone walks, talks, interacts with others, and

makes decisions; therefore, everything an individual does is purposeful, whether through

conscious or unconscious decisions (Powers & Griffith, 2012).

Bitter (2009) described Individual Psychology, or Adlerian therapy, as a family-centered,

systemic approach. Bitter suggested that the first step of this family-centered approach would be

to consider the family constellation, which consists of the parents, children, and extended family

members. Bitter then identified a client’s birth order that is, first born, middle child, youngest,

or only child within the family constellation. Lastly, Bitter identified an individual’s

interpretation, definition, and meaning of their position in the family. Bitter stated these factors

played an important role in how an individual interacted with the family system and the world.

In addition, Bitter reported that to understand an individual’s symptoms, one must gain an


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understanding of the purpose of behavior. For this reason, seven Adlerian concepts will be

reviewed: movement, self-concept, style of life, organ inferiority, organ dialect, compensation,

and social interest.

Movement

Ansbacher and Ansbacher (1964b) stated that every individual had a unique law of

movement, that is, the way the individual functions and moves through life. Ansbacher and

Ansbacher stated that the individual’s goal of movement was to strive to overcome difficulties

throughout the person’s lifetime. Ansbacher and Ansbacher noted that from birth, individual

striving created goals to achieve perfection, security, completion, and the meaning of life.

Furthermore, the attitude and convictions of an individual are determined by the goals within the

law of movement. At times, individuals see that some goals are faulty, so adjustments are made

to the goals.

Self-Concept

Mosak and Maniacci (1999) reported people use statements such as “I am” or “I am not”

to create self-concept, which is first created by the mother. Mosak and Maniacci explained that

Adler believed the mother was responsible for various tasks to ensure her child builds a healthy

self-concept. The first task was for the mother to bond with the child through empathy. The

second task was for the mother to “spread” (p. 51) interest to the father. Then, the father and the

mother spread interest to the family and the rest of the world. For a child to develop a healthy

self-concept, a mother should show empathy, match and validate the child’s emotions, and teach

social responsibility and appropriate limits (Ansbacher & Ansbacher, 1964a; Mosak & Maniacci,

1999). An individual with a healthy self-concept is resilient and cooperates with the needs and

perspectives of others (Mosak & Maniacci, 1999).


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Style of Life

The style of life is defined as how an individual navigates through the environment

through thinking, feeling, and acting (Mosak & Maniacci, 1999). The style of life is constructed

through various factors such as upbringing and life experiences. Mosak and Maniacci further

detailed that as an individual biologically and psychosocially matures, the style of life

convictions are the same with everyone. Ansbacher and Ansbacher (1964a) noted that an

individual’s style of life can be seen more clearly when they are faced with challenging

situations. In an individual’s style of life, the goal is to define the individual’s view of success,

or, the goal for superiority. The goal of superiority in a discouraged individual is to feel superior

over others, oftentimes not realizing the impact the striving for superiority has on others (Powers

& Griffith, 2012).

Organ Inferiority

Ansbacher and Ansbacher (1964a) stated Adler contributed to the theory of disease, and

how disease affected the inferior organ, through the concept of organ inferiority. Adler stated

that organ inferiority was the way in which the mind and body compensated for disease and how

the inferior organ was inferior to the total situation of an individual (as cited in Ansbacher &

Ansbacher, 1964a).

Organ inferiority assumed two functions: the individual’s interpretation of development

and how the psyche expressed itself through the inferior organ (Ansbacher & Ansbacher, 1964a).

Additionally, the body can speak more clearly than words and reveal signs of anxiety, fear,

worry, and pain (before words are spoken). In reciprocal fashion, the neuroses related to organ

inferiority, and the organ inferiority related to the neuroses.


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Organ Dialect

Ansbacher and Ansbacher (1964a) referred to organ dialect as when the body was

subject to the law of movement and ultimately had a language of its own. Organ dialect involved

the process in which individuals expressed emotions through the body whether it was visible

through posture and attitude, or a stomach ache when nervous or filled with anxiety. According

to Ansbacher and Ansbacher, similarities exist within the family system. Organ dialect may

provide information regarding certain emotional and physical peculiarities within the family tree.

One example of a shared organ dialect within the family system is anxiety, which Adler

described as a craving for power. This craving for power is to compensate for the manifestations

of fears, specifically the fear of defeat (Ansbacher & Ansbacher, 1964a).

Compensation

Compensation is derived from the concept of organ inferiority (Ansbacher & Ansbacher,

1964a). The mind will compensate for the inferior organ in an effort to maintain equilibrium.

More specifically, Adler determined that the leading cause of compensation was over-

performance and increased growth of the brain. Oberst and Stewart (2003) noted that a person

who had a healthy upbringing could compensate for experienced difficulties and help others,

therefore, maturing into a psychologically healthy individual.

Social Interest

Social interest, also known as Gemeinschaftsgefūhl, is the most important part of the

individual that assists in the person’s response to reality within social situations; it is the attitude

towards life, or Lebensform (Ansbacher & Ansbacher, 1964a). Ansbacher and Ansbacher further

defined social interest as the driving force in an individual who is striving for superiority or

perfection. They reported social interest was developed by the individual through the


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understanding of the social context of the environment. This development was constructed early

in life through caregivers, specifically, the mother. Ansbacher and Ansbacher noted that the

relationship with the mother was important because the mother and child are dependent on each

other by nature. In fact, this relationship is where social interest is born.

Ansbacher and Ansbacher (1964a) highlighted empathy and understanding as important

aspects of social interest. For instance, empathy and understanding develop early in life when

individuals are trained how to relate to others. Specifically, this development translates

throughout life and produces the lens through which the individual views life.

Individual Psychology and Mental Health

Adler, founder of Individual Psychology, was a physician who discovered theories within

the medical field and determined that the body and mind were connected (Ansbacher &

Ansbacher, 1964a). Adler was ahead of his time in his discoveries in counseling and

psychotherapy (Watts & Carlson, 1999). Oberst and Stewart (2003) considered Individual

Psychology, or Adlerian theory, a growth model where the dysfunctional individual would be

considered a discouraged individual. Ansbacher and Ansbacher (1964a) defined a discouraged

individual as one who believes their situation will not improve, and as one who struggles with

feelings of inferiority (inferiority complex). In addition, Ansbacher and Ansbacher noted that a

neurosis was associated with each feeling of inferiority. Oberst and Stewart (2003) suggested

that all neuroses have a common origin and the entire person would need to be assessed.

Additionally, Oberst and Stewart believed that understanding an individual’s lifestyle was of

upmost importance, as it revealed the way an individual navigated through life.


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Family of Origin

Ross et al. (2016) reported that a child first learned about relationships in the family unit.

Specifically, a child learned how to socialize with others and learned about the beliefs and

expectations of relationships. Ross et al. stated that behavior problems and adolescent alcohol

use are common characteristics of a child who experienced inconsistent parenting. Ross et al.

highlighted two assessments that could aid in the understanding of a child’s home life. The first

assessment is the Confusion, Hubbub, and Order Scale (CHAOS), which evaluated the lack of

calmness and routine in the home. The second assessment was the Family Unpredictability

Scale (FUS), which evaluated parental reports of inconsistencies in the home. These two

assessments revealed that higher scores are correlated with less optimal parenting, higher rates of

attention, behavior, and conduct problems in children, and high rates of family dysfunction.

These factors, along with parental anxiety and depression symptoms, parental alcoholism,

parental inconsistency, divorce rates, and economic adversity, created instability in a child’s life.

Ross et al. concluded that this instability can send the message to the child that people are

undependable and the world is unstable, which could be contributing factors of mental health

difficulties.

The Neglected Child

Ansbacher and Ansbacher (1964a) stressed that a neglected child would have a more

difficult time adopting a positive outlook in life. This is due, in part, to the limited positive

experiences of love and cooperation. Ansbacher and Ansbacher emphasized that a neglected

child would experience greater difficulties and a reduced ability to overcome these difficulties.

As a result, a neglected child could become isolated because they feel as though life and people

are not safe.


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Ansbacher and Ansbacher (1964a) noted that adults who were once neglected as children,

believed their children should not be happier than they were. That is, poor mothering can

hardwire our brains to become sensitive to stress (Mayer, 2016). This hardwiring could be

perpetuated over generations and increase the likelihood of brain disorders.

Epigenetics

Leaf (2013) highlighted an important player in the outcome of our health: epigenetics.

Epigenetics is defined as the intergenerational transmission of genetic traits (Mayer, 2016).

Mayer stated one way to view epigenetics is that they are hereditary tags on the DNA. An

example would be poor mothering. For instance, Mayer suggested that the way a mother

nurtures her newborn chemically modifies the newborn’s genes. The method of nurturing tags

the newborn’s DNA, possibly altering the brain signals, which then passes the mother’s methods

of parenting onto her child (Mayer, 2016). Since the brain signals were tagged with the mother’s

method of nurturing, the child then grows up to nurture the same way, continuing the cycle

(Mayer, 2016). Mayer made the connection between the mother and child interaction and the

development of the child’s brain and gut. This connection is similar to what Adler concluded:

For a child to have a strong sense of self and make a positive impact on this world, the role of the

mother is crucial (Mosak & Maniacci, 1999).

Nutrition and Mental Health

“Let food be thy medicine and medicine be thy food”

--Hippocrates

Current epidemiologic evidence has revealed a significant amount of correlation between

the status of our mental health and what we eat (Freeman, 2010; Weltens, Zhao, & Van

Oudenhove, 2014). Turner (2011) reported that over the years, food education focused on how


23

food provides substance to the body; however, Turner noted that food provided more than just

energy. According to Turner, food choices influence the molecular systems that maintain mental

functions.

Eating Habits

Weltens et al. (2014) reported normal eating behavior was controlled by energy balance

and emotional-motivational processes. For instance, energy balance was regulated by the

homeostatic system, which signaled the brain to control energy intake and expenditure based on

what the body needs. Weltens et al. stated that this process was part of a large neural system that

attributed rewarding properties to foods and produced emotional responses. These rewarding

properties included sight, smell, taste, and texture, all of which resulted in the affective value of

food. As noted by Weltens et al., this process could be disrupted under certain conditions or

disorders (i.e., stress or obesity).

Currently, people suffer from obesity and malnutrition (Leaf, 2016; Weltens et al., 2014).

Leaf pointed out that the fast-paced lifestyle lived by most had a direct impact on how and what

individuals ate. Additionally, Leaf noted that the convenience of restaurants, drive-thru

establishments, and over-processed, high-calorie packaged foods have become the norm instead

of healthy, homemade meals. Richards and Sindelar (2013) noted that although calories are on

food packaging or restaurant menus, people are not completely deterred from eating foods high

in calories. Over-processed, high-calorie, high-fat, food-like packaged products typically contain

ingredients, such as corn, soy, and wheat to extend the shelf life of the food (Leaf, 2016).

According to Turner (2011), the Western diet included a decreased consumption of

healthy foods high in omega-3 fatty acids and an increased consumption of processed foods high

in omega-6 fatty acids. Although omega-6 foods are essential to our diet, excess consumption


24

leads to health issues (Turner, 2011). Turner listed several excellent food sources of omega-3

fatty acids: grass-fed beef, cold-water fish (salmon), flax, hemp, and chia seeds. Comparatively,

Turner listed foods laden with vegetable oil, soybean, corn, cottonseed, salad oils, and margarine

which are high in omega-6 fatty acids. Turner reported that the transition of eating less omega-3

and more omega-6 foods increased allergic and inflammatory diseases, such as asthma, diabetes,

cardiovascular disease, and arthritis.

Many people today, specifically those with lower socioeconomic status, have a limited

understanding of proper nutrition (Richards & Sindelar, 2013). Turner (2011) reported that

children and adolescents deficient in nutrients had a higher likelihood of mental or behavioral

functions. This nutritional deficiency could have long-term adverse effects on the child or

adolescent because as they grow older, learned eating habits typically stay with the child into

adulthood. A lack of proper nutrition throughout adulthood can cause continued health concerns,

such as brain disease, premature aging, and Alzheimer’s (Perlmutter & Loberg, 2015; Turner,

2011).

Children who engaged in regular family meals experienced lower levels of depression

and experienced social and academic benefits when compared to children who did not have

regular family meals (Ross et al., 2016). More specifically, Enders (2015) revealed that family

meals conducted in a calm environment, facilitated a healthy digestive process. Enders further

revealed that the consumption of food in stressful environments caused stress to the gut. The

reason for this was because stress prevented the extraction of energy from food and it took a

longer period of time for the body to digest the food.


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Foods

Hurley (2011) found over the past century, drastic changes occurred within the American

diet. The most obvious change was that people consume highly processed foods void of

nutrients and bacteria that have been crucial to our health for centuries. This phenomenon was

referred to as the Modern American Diet (MAD) or, Western diet (Freeman, 2010; Leaf, 2016).

A Western diet consisted of meat pies, processed meats, pizza, chips, hamburgers, white bread,

sugar, flavored milk drinks, and beer (Freeman, 2010). In contrast, Freeman reported a

traditional diet consisted of vegetables, fruit, beef, lamb, fish, and whole-grain foods.

As a result of the MAD diet, changes altered the gut flora and left the system vulnerable

to physical ailments, immune disorders, and mental conditions (Hurley, 2011). Freeman (2010)

reported that when individuals consume a Western diet, they are at an increased risk for

depressive disorders, such as anxiety. According to Leaf (2016), when people consumed a

Western diet, the added chemicals and lost nutrients in highly processed foods contributed to the

increased risk of mental health issues. Alternately, Freeman (2010) reported the risk for

depressive disorders decreased when individuals consumed a traditional diet.

Consumption of over-processed, high-calorie, high-fat foods have naturally rewarding

properties, such as the palatability of food, the pleasure it induces, and the anticipation of

consumption (Weltens et al., 2014). These rewarding properties temporarily reduce stress and

negative moods (Mayer, 2016; Weltens et al., 2014). Specifically, stress and negative mood is

reduced through the method of how the fat is processed through the body (Mayer, 2016). Mayer

concluded that the fatty acids stimulated the release of signaling molecules from the gut. These

signaling molecules communicated with the emotional brain regions through circulation or the

vagus nerve. Mayer defined the vagus nerve, which stimulates gut function, as one of two nerve


26

signals the brain sends to the digestive tract. In spite of the reward that over-processed, high-

calorie, high-fat foods provide, the reward is not lasting and is detrimental to the body (Leaf,

2016).

Paikin (2015) reported that fructose had a negative impact on gut health. When an

individual ate a diet high in carbohydrates and refined sugar, insulin levels spiked and caused a

major imbalance in the hormonal system (Perlmutter & Loberg, 2015; Turner, 2011). Perlmutter

and Loberg (2015) stated that a diet high in carbohydrates and refined sugar created higher levels

of glucose and reduced the number of insulin-response receptors. (Insulin transports glucose into

the cells through cell receptors.) This change caused the cells to become resistant to insulin and

prevented the cell from taking glucose from the blood. The glucose remained in the bloodstream

and signaled the pancreas to increase the production of insulin. This increase of insulin

production kept the cells resistant to insulin and created an unhealthy cycle. This imbalance can

create inflammation in the body as well as diabetes and brain disease (Perlmutter & Loberg,

2015).

Food is Medicine

Hyman (2012) suggested real food is the best medicine. Real food, or whole food,

consists of fresh fruits, vegetables, meats, dairy products, nuts, seeds, and whole unrefined grains

that are “free of synthetic chemicals, whole or minimally processed, and are ecologically

diverse” (Leaf, 2016, p. 23). These foods are sources of vitamins, minerals, and magnesium.

Real foods increase higher levels of dopamine and norepinephrine, which create alertness and

mental energy (Nussbaum, 2015; Turner, 2011). Any added fiber, plant based and fiber rich, to

the diet would benefit the immune system and promote health (Lapine, 2015). According to

Lapine, it is important choose and consume fiber-rich foods. Leaf (2016) suggested that healthy


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foods are more nutritious (e.g., meats are higher in omega-3 fatty acid content) and taste better

than unhealthy foods.

Leaf (2016) mentioned that seasonal, local, and natural have become trendy words used

in the food industry and can categorize the way food should be eaten. Leaf specified that fresh

fruits and vegetables (predominately local and seasonal) and wild, grass-fed meats are preferred.

Leaf suggested that food from a local community-supported agriculture (CSA) would be one

way to ensure an individual acquired the most nutritious foods possible.

Turner (2011) found that certain food types influenced how a person felt, acted, and

processed thoughts. Specifically, brain lipids (fats), essential fatty acids (EFAs), omega-3 fatty

acids, and antioxidants influenced feelings, thoughts, and actions. Brain lipids store chemical

energy and are structural components of cell membranes. Essential fatty acids influence “vision,

nervous system function, immune and inflammatory responses and modulation of gene

expression” (Turner, 2011, para. 15). For instance, cognitive decline correlated with diets high

in saturated fat and foods rich in medium-chain triglycerides (MCT), such as coconut oil and

palm oil, improved cognitive performance in memory-impaired adults. In addition, Turner

reported that vitamin B and D improved cognitive functions and antioxidants (e.g., fruits,

vegetables, spices, vitamin C, and vitamin E) reduced brain aging behavior. Also, Turner found

that Tyrosine, an amino acid that is abundant in protein-rich meals, manufactured dopamine and

norepinephrine through the assistance of folic acid, magnesium, and vitamin B12.

Food has a direct impact on the neurohormones located in the gut that generate certain

signals to the brain (Hurley, 2011). For example, eating a diet high in fatty acids could reduce

feelings of sadness and hunger urges by 50%. According to Freeman (2010), single nutrients,

such as omega-3 fatty acids and folates, are highlighted in epidemiological and treatment studies.


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Time

Leaf (2016) indicated that the advances in technology made it easier for individuals to

work more and monopolize time needed for other important aspects of life, such as healthy

eating. For instance, living under the constant pressure of time constraints can produce chronic

stress and ailments that affect an individual’s mental health. In today’s busy society, it is easier

to eat fast food from a restaurant or out of a box from the grocery store. Leaf posited that at the

end of the day, most individuals preferred to sit down and excessively watch a favorite television

program rather than prep and cook a healthy meal.

Supplements

Turner (2011) stated that the modern American diet made it difficult to eat healthy foods

that provided the proper nutrients needed for daily intake. Many individuals are deficient in

important nutrients, so extra nutritional support is needed; however, supplements should be

carefully considered with the help of an experienced nutrition professional. The supplements

purchased should be high-quality, in bio-available forms, and free of filler ingredients (Turner,

2011).

Gut Health

“All disease starts in the gut”

--Hippocrates

Unlike any organ in the body, the gut can work independent of the control of the central

nervous system (CNS) and brain (Hurley, 2011; Mayer, 2016; Trindade & Murphy, 2015). The

enteric nervous system (ENS), which is in the gut and is part of the autonomic nervous system

(ANS), acts as a second brain and has a direct impact on our mental health (Harrington, 2016;

Hurley, 2011; Mayer, 2016; Trindade & Murphy, 2015). According to Ansbacher and


29

Ansbacher (1964a), mental tension affects the CNS (e.g., drumming on the table or chewing a

pen) and the ANS (all emotion). Trindade and Murphy (2015) reported that an imbalance in the

gastrointestinal (GI) tract can cause an imbalance in the CNS.

The ANS is the body’s subconscious system, facilitating psychological and chemical

changes in the body without consciously thinking about the change (Dispenza, 2014). The ENS

relies on, and manufactures, 30 neurotransmitters. Neurotransmitters, such as serotonin, are

similar to those located in the brain (Hurley, 2011). Hurley stated that the ENS sends signals to

the brain that can affect feelings (e.g., sadness and stress). There are 100 million neurons, or

nerve cells, located in the ENS that work independently from the brain to control the movement

and absorption of food in the intestines (Hurley, 2011; Mayer, 2016). Also, the ENS regulates

the entire digestive process and communicates with the CNS (Trindade & Murphy, 2015). This

communication between the brain and the gut is bidirectional and is commonly referred to as the

gut-brain axis (Harrington, 2016; Schmidt, 2015; Schmidt et al., 2015; Sonnenburg &

Sonnenburg, 2015; Trindade & Murphy, 2015).

Trindade and Murphy (2015) and Schmidt et al. (2015) stated there are different routes of

communication from the gut to the brain. The first route is through the sensory neurons, which

transmit information from the gut to the brain (Trindade & Murphy, 2015). The second route is

through cytokines or molecules that influence the brain and alter moods (Mayer, 2016; Trindade

& Murphy, 2015). The third route of transmission is through gut hormones, which are hormones

that are discharged throughout the gut (Trindade & Murphy, 2015). The last method of

communication is the gut microbiota-derived signaling molecules. Gut microbiota-derived

signaling molecules transmit information within the gut and send it to the brain. The brain then


30

communicates to the gut by autonomic neurons and neuroendocrine factors that carry output

from the CNS to the intestines (Trindade & Murphy, 2015).

Perlmutter and Loberg (2015) and Trindade and Murphy (2015) reported brain diseases,

brain health, and mood disorders are largely influenced by the health of our gut. That is, what

transpires in the brain and the gut are directly correlated with one another. In fact, Perlmutter

and Loberg (2015) reported an unhealthy gut is found to be the source of 90% of all known

human illness. Trindade and Murphy (2015) reported up to a 60% comorbidity of anxiety and

gastrointestinal disorders; however, Perlmutter and Loberg (2015) suggested that an individual

has some control over the health of the gut.

The Gut

Mayer (2016) stated that the digestive system (gut) and the nervous system (brain) are the

two most complex and crucial systems in the body. The gut, a vast sensory organ, encodes

information (hot, cold, sweet, spicy) found in food. Additionally, Mayer reported the gut

provides sensations to alert the brain that the gut is full or nauseous. Hurley (2011) posited that

the bacteria in our gut and our brain are in constant communication. This constant

communication shapes how the brain is wired and has a direct impact on the amygdala and

hippocampus.

Microbiota

Over the course of human history, the microbes in the gut grew accustomed to a diet rich

in fiber (Lapine, 2015). In modern culture, Lapine suggested the western diet has been void of a

fiber-rich diet, forcing the microbes in the gut to begin feeding on the mucus in the gut. Lapine

stated this change had a negative impact on health. Hurley (2011) reported that food and the gut

flora have a direct impact on one another. While diet is the main contributor to the decline of


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healthy microbes in the gut, other factors such as antibiotics, C-sections, sanitation, and lack of

breast feeding contribute to the declining health of the microbes in the gut (Lapine, 2015).

Trindade and Murphy (2015) suggested that gut microbiota health determines the health

of the brain and vice versa. Gut microbiota have a significant impact on the brain and an inferior

gut microbiota has been associated with neuropsychological disorders. Perlmutter and Loberg

(2015) and Harrington (2016) stated there are approximately one hundred trillion microbes in the

mouth, ears, nose, genitalia, and skin (most of them live in the digestive tract). There are nearly

100 times more microbes than there are genes and 360 microbial genes for every human gene

(Harrington, 2016; Mayer, 2016). Schmidt et al. (2015) reported over 7000 bacterial strains in

the adult gut microbiota and the CNS and microbiota develop and interact within the first three

years of life.

Birth

Individuals have unique microbiota, much like each person has unique fingerprints

(Trindade & Murphy, 2015). The gut microbiota reflects the environment individuals have been

exposed to since birth, starting with the mother’s method of delivery (Schmidt et al., 2015;

Trindade & Murphy, 2015). A child born via a vaginal birth has a greater number of healthy

bacteria compared to a child delivered by C-section (Perlmutter & Loberg, 2015; Trindade &

Murphy, 2015). This is because the vaginal lining fosters healthy bacteria passed on to the child

as they exit the vaginal canal (Perlmutter & Loberg, 2015).

Perlmutter and Loberg (2015) reported that there are two types of microbes found in

babies that are born vaginally. The first, Lactobacillus, is a superior microbiome because it can

create an acidic environment in the body, which wards off the growth of any bacteria that is

deemed potentially harmful (Perlmutter & Loberg, 2015; Schmidt et al., 2015). The second,


32

Bifidobacteriais gut bacteria that assists in the maturity of the gut lining (Perlmutter & Loberg,

2015). Those born via C-section lack the Lactobacillus and Bifidobacteria microbiomes and are

exposed to powerful antibiotics at birth (Perlmutter & Loberg, 2015; Schmidt et al., 2015). Also,

nearly one third of babies born in the U.S. are born via C-section (Perlmutter & Loberg, 2015).

As a result, if this trend continues, nearly half of the babies born in 2020 will be born via C-

section. Consequently, babies born via C-section will begin life without the "founding

populations" of microbes that have been around since the beginning of time.

Following birth, breast feeding can help determine the diversity of microbes in a child

(Perlmutter & Loberg, 2015; Trindade & Murphy, 2015). A child’s first solid foods, if an

individual had siblings, diet and lifestyle, amount of travel, use of antibiotics, genetics, sex, and

age are other determining factors that can influence the gut microbiota (Trindade & Murphy,

2015). The transmission of microbes from one generation to the next is essential to the process

of life (Perlmutter & Loberg, 2015). More specifically, the establishment of gut microbiota in

the post-natal stage of life plays a critical role in the development of the brain (Mayer, 2016;

Schmidt, 2015). Geographical and cultural factors, infections, and antibiotic use determine the

type of gut microbiota developed early in life (Schmidt et al., 2015). These factors, along with

early scars from life experiences, whether through the birthing process, stressors, or dietary

intake, can follow a child into adulthood (Schmidt, 2015).

Perlmutter and Loberg (2015) reported there are three forces working against the

microbiomes in your gut: a western diet, lack of nutrients, and stress. Perlmutter and Loberg

found that the western diet, use of antibiotics, and overly sanitized conditions are contributing

factors to why people in the U.S. suffer from "western" diseases. Schmidt et al. (2015) and

Mayer (2016) correlated an unhealthy gut microbiome to early-life stress. Harrington (2016)


33

reported that early life stress could change the microbes in your gut through increased levels of

cortisol stress hormones.

Paikin (2015) stated that some microbiota influence 10-30% of body weight and could

contribute to obesity. Paikin reported that the more diverse the gut bacteria, the healthier a

person is and the more an individual is protected from obesity. In addition, Paikin suggested that

microbiota can influence mood. For instance, the lower the levels of microbes, the higher the

levels of the stress hormone cortisol, and the releasing adrenocorticotropic hormone (Harrington,

2016). Hurley (2011) and Schmidt et al. (2015) reported that modifying the microbiota may be

useful in the regulation of the cortisol stress hormone and assist in the treatment of stress-related

disorders. In fact, Paikin (2015) suggested that the types of microbiota that live in the gut are

created by how one cares for the body.

Leaky Gut

Leaky gut can be defined as abnormal intestinal permeability (Bongiorno, 2014; Trindade

& Murphy, 2015). Bongiorno (2014) stated that the conventional medical world believed there

was little evidence to support the theory of the leaky gut; however, recent research revealed a

correlation between functional bowel disorders, such as irritable bowel syndrome (IBS), and

psychiatric illnesses, such as anxiety or depression (Bongiorno, 2014; Mayer, 2016). Symptoms

of IBS occurred between the ages of 18-25 and included abdominal pain, diarrhea, vomiting,

fever, and weight loss (Mizrahi et al., 2012). Mayer stated chronic stress is one reason for a

leaky gut. Chronic stress contributes to leaky gut because stress can cause thinning of the mucus

layer lining the colon and reduce the capability of the gut to defend the body against pathogens

(Mayer, 2016). For example, Mayer stated that after an infection clears, the effects of chronic

stress prolong the symptoms.


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Prebiotics

Prebiotics feed good bacteria and are found in dietary fiber and complex carbohydrates

(Lapine, 2015; Perlmutter & Loberg, 2015). Prebiotics are found in several foods such as garlic,

onions, leeks, asparagus, and jicama (Perlmutter & Loberg, 2015). Prebiotics provide many

health benefits, yet most American’s do not get enough in daily food intake. Perlmutter and

Loberg recommended 12 grams of prebiotics daily from real foods and supplements. According

to Perlmutter and Loberg, significant health benefits exists in prebiotics. First, prebiotics reduce

fever-related diseases associated with diarrhea. Second, they reduce the amount of antibiotics

infants need. Third, prebiotics reduce inflammation in inflammatory bowel diseases. Fourth,

prebiotics increase the absorption rate of minerals in the body. Fifth, prebiotics lower the risk

factors associated with cardiovascular diseases. Finally, prebiotics influence weight control by

providing a sense of fullness.

Probiotics

Probiotics, known as beneficial bacteria, help process food and sustain the body (Hurley,

2011). Probiotics reduce inflammatory cytokines (signaling molecules), balance hormones, have

a positive impact on the nervous system, reduce subjective feelings of anxiety, and outcompete

toxic intestinal products (Harrington, 2016; Schmidt et al., 2015). To date, research in probiotics

and prebiotics primarily involves testing rats or mice (Ender, 2015; Schmidt et al., 2015).

Perlmutter and Loberg (2015) pointed out that most people believe all bacteria is bad; however,

this is not accurate because the body requires certain levels of good bacteria, specifically in the

gut, to live in complete health. In fact, Paikin (2015) reported 95% of the bacteria in the world

would not be harmful to humans.


35

Harrington (2016) reported two specific probiotic organisms, Lactobacillus Helveticus

(R0052) and Bifidobacterium Longum (R0175), helped improve anxiety by 55% and decreased

depression scores by 50%. Harrington noted that these select strains are derived from those

commonly found in the gastrointestinal tract and have been developed for the effect on brain

chemistry. The effective and safe combination of Lactobacillus Helveticus and Bifidobacterium

Longum reduced anxiety and depression symptoms as well as the stress and anxiety-promoting

hormones (Harrington, 2016).

Lapine (2015) reported that the consumption of dietary fiber and fermented foods or

probiotic supplements are two primary methods to create a healthy gut. One reason is that

bacteria in fermented foods and probiotics do not occur naturally in the gut. Because of this, the

consumption of probiotics derived from a wide variety of fermented foods that work with your

system, such as kombucha, sauerkraut, and yogurt, must occur on a regular basis (Lapine, 2015).

Brain Health

“In good health is a duty, otherwise we shall not be able to keep our mind

strong and clear”

--Plato

The brain is a complicated and complex organ because it is cognitive, emotional, motoric,

spiritual, and behavioral (Nussbaum, 2015). In fact, all coordinated networks of the brain are

connected, and work together (Leaf, 2013). Over the past 20 years, research provided new

information on the function of the human brain (Nussbaum, 2015). For example, outdated

research concluded that the brain was unchangeable; however, new research points to additional

information about the brain: plasticity and resiliency. Nussbaum defined plasticity as the brain

possessing the capacity to change and resilience as a product of plasticity, where the neurons, or


36

brain cells, maintain health and protect against disease. Additionally, current research suggests

that the health of the brain is dependent upon many factors, including, but not limited to, levels

of stress, sleep, proper nutrition, and anxiety.

Nussbaum (2015) stated a healthy brain can be obtained by engaging in a comprehensive

and holistic approach to a healthy lifestyle. This healthy lifestyle would include physical

activity, mental stimulation, spirituality, nutrition, and socialization. According to Nussbaum:

• The brain demands 25% of blood from each heartbeat, so physical activity, such as

walking, yoga, and weight training, fosters a healthy brain. In fact, the brain needs to be

stimulated to develop brain resilience.

• Learning a new language, playing a musical instrument, engaging in creative pursuits,

playing board games, reading, and writing are ways in which the brain can be stimulated.

• Spirituality practices – religious or non-religious – bring balance and inner peace.

Meditation, daily prayer, forgiveness, yoga, deep breathing, muscle relaxation, and

focusing on positive ideas, emotions, and feelings are all spiritual practices to consider.

• Eating proper fats, vitamins, minerals, EFAs, high fiber, and phytonutrients provide

energy, cognition, and motor skills.

• Isolation is bad for the brain. In an effort to combat isolation, individuals could develop a

network of supportive and caring friends, become a forgiving spirit, and engage in social

functions and recreation.

In addition to the aforementioned, Turner (2011) reported that proper brain function

requires a steady flow of glucose derived from proper nutrition throughout the day. According to

Turner, food manufactures four neurotransmitters in the brain that affect behavior, eating

patterns, sleep, and energy levels. These four neurotransmitters are acetylcholine, dopamine,


37

norepinephrine, and serotonin. Serotonin is a signaling molecule essential for normal intestinal

functions, sleep, appetite, pain sensitivity, mood, and well-being (Mayer, 2016). Serotonin is

found in protein-rich foods and 95% of serotonin is manufactured in the cells of our gut (Enders,

2015; Mayer, 2016; Turner, 2011).

Environmental Influences

Jacka, Rothon, Taylor, Berk, and Stansfeld (2013) found a correlation between

adolescents with a low socioeconomic status and dietary health. In addition, individuals and

families with low socioeconomic status suffered from higher obesity rates and poor nutrition

(Richards & Sindelar, 2013). Poor nutrition in children and adolescents prevented proper

development, well-being, and healthy eating habits later in life.

Early Life Adverse Events

Mayer (2016) connected early life adverse events, up to the first eighteen years of life,

and medical problems, specifically chronic gastrointestinal disorders. Adverse events were

traumatic in nature: verbal, sexual, physical, and emotional abuse, major illness, divorce,

addiction, poverty, and household dysfunction related to the parents. The connection between

early life adverse events and medical problems was discovered by asking patients a simple

question: “Do you think you had a happy childhood?” (Mayer, 2016, p. 108). This simple

question prompted patients to recollect traumatic experiences from the first eighteen years of life.

Through this process, patients finally understood how early childhood events had a direct impact

on health. The patients in Mayer’s 2016 study were previously prescribed a cocktail mix of

pharmaceuticals from prior doctors to alleviate the physical pain and emotional issues that

coincided with the disorder. This cocktail mix did not alleviate the symptoms, leaving the

patients to continue in the search for answers. One patient reported almost losing faith in the


38

medical profession until meeting with Mayer. Mayer’s exploration of early life experiences

brought to light the fact that these experiences had a direct influence on health.

Role of the Mother

Rat study. According to Mayer (2016), Plotsky and Meaney conducted a study on

mother rats who were nurturing or naturally negligent towards their pups. Plotsky and Meaney

concluded that the rat pups with nurturing mothers had lower levels of corticosterone (equivalent

of cortisol in humans) and hormonal changes in the blood and brain that minimized the stress

response. In contrast, the rat pups with negligent mothers had a higher production rate of

corticotropin-releasing factor (CRF), a critical stress molecule that sends the brain and body into

stress-response mode, and systems that are less efficient in regulating the stress responses.

Human study. Further research was conducted on humans to gain an increased

understanding of what happens to the human brain when a person experienced early adversity

(Mayer, 2016). Through the use of neuroimaging, technology that looks directly into the brain,

Mayer explained that researchers discovered the brain structure and the neural activity in brain

networks are continuously rewired by life experiences. Mayer noted that this rewiring of the

brain has a direct impact on a person’s mental and physical health and their ability to handle

stress.

Stress

Hellhammer and Schubert (2013) defined stress as reactions, whether physical or mental,

caused by external stimuli that allow individuals to cope with life situations. In addition, an

increase in stress can cause physical ailments, such as gastrointestinal disorders, anxiety, and

emotional disturbances. Chronic stress is one of the most common factors in anxiety and it can

cause physical or psychological damage over time (Harrington, 2016; Nussbaum, 2015; Trindade


39

& Murphy, 2015). Some physiological factors predisposing individuals to a mood disorder, such

as anxiety, are: gut bugs, food allergies or sensitivities, digestive insufficiencies or excess, leaky

gut, and inflammation (Harrington, 2016; Nussbaum, 2015; Trindade & Murphy, 2015). As a

result, anxiety is a symptom of a greater imbalance in the body (Trindade & Murphy, 2015).

Activation of Stress

When the brain receives signals of perceived or actual threat, Mayer (2016) stated the

stress program in the brain is activated. Mayer posited that this part of the brain then

communicates to the body that a stressful situation has occurred and initiates responses within

the body, specifically the gastrointestinal tract. During this process there are signaling

molecules, or hormones, in the brain that communicate with the body. These hormones are

called endorphins, dopamine, oxytocin, and CRF. They have different functions but serve the

same purpose: to help manage stress in the body. Specifically, endorphins act as a painkiller,

dopamine activates desire and motivation, oxytocin stimulates feelings of trust and attraction,

and CRF is a stress signaling system that regulates cortisol. Cortisol regulates the immune

system by metabolizing proper amounts of fat, protein, and carbohydrates (Mayer, 2016).

Mayer (2016) found that when stress is triggered in the body, there is a process to which

the body responds in an effort to protect itself. First, the hypothalamus, a small part of the brain

that controls the vital functions and produces CRF, responds to the stress by releasing CRF.

When CRF is released, it serves two functions: activating the adrenal gland and notifying the

amygdala. The adrenal gland produces cortisol. The amygdala is a region of the brain that is the

source of anxiety or fear. When CRF signals the adrenal gland, the adrenal gland releases

cortisol. The cortisol then gets dispersed in the bloodstream, preparing the body for metabolic

demand. At the same time, CRF signals the amygdala, triggering fear and anxiety, creating


40

reactions in the body such as heart palpitations and the urge to go to the bathroom. This stress

response can stay in the body for long time, sometimes even years, which can have detrimental

effects on the gut-brain axis (Mayer, 2016).

Bongiorno (2012) stated that individuals who are stressed oftentimes eat foods high in

sugar, fat, and salt content. The reasoning for this is because the brain is looking for glucose,

which provides energy. Since the brain uses up half of the calories ingested during the day, and

stressed individuals search for foods high in sugar, the cycle of unhealthy eating ensues. Not

only are stressed individuals eating unhealthy, they do not participate in exercise or proper sleep.

These factors combined produce low moods and feelings of anxiety and depression.

Action Steps

“Physical exercise is not merely necessary to the health and development of the body, but

to balance and correct intellectual pursuits as well. The mere athlete is brutal and Philistine, the

mere intellectual unstable and spiritless. The right education must tune the strings of the body

and mind to perfect spiritual harmony”

--Plato

Interventions

Learning new healthy behaviors can retrain the brain, particularly in our prefrontal

cortex, causing a positive reaction in our health (Mayer, 2016). For example, interventions, such

as cognitive behavioral therapy, meditation, and exercise, can teach individuals new behaviors to

handle and reduce stress. Mizrahi et al. (2012) stated relaxation practice promotes physiological

and mental rest. Mizrahi et al. pointed out that relaxation has many benefits that contribute to

lowering stress in the body. The reduction of stress ultimately lessens brain-gut symptoms and

anxiety and depression (Mayer, 2016).


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Changing Habits

Richards and Sindelar (2013) reported the MAD, or unhealthy eating habits, was greatly

influenced by certain behavioral concepts, such as cognitive overload, cues, present bias,

salience, and self-control. The first behavioral concept, cognitive overload, refers to complex

nutritional information located on food packaging. The second behavioral concept refers to the

cues and packaging of food designed to create a sense of hunger and desire for the food. The

third behavioral concept, present bias, refers to the lack of understanding regarding the

connection between unhealthy eating and the potential for a negative impact on an individual’s

future health. Salience, the fourth behavioral concept, refers to information located at the point

of purchase regarding the health, or lack of health, benefits of the food. The final behavioral

concept, self-control, refers to the individual’s lack of self-control to resist unhealthy foods.

These behavioral concepts influence an individual’s ability to make healthy lifestyle changes.

Perlmutter and Loberg (2015) noted that there are other steps to take when making

healthy lifestyle changes, most of which minimize the amount of chemicals that are ingested

through foods. For example, some plastics contain harmful chemicals that seep into foods or

beverages. Plastic containers or plastic wrap with the “3” recycling code should be avoided, as

this plastic is made from PVC. In addition, it is best to avoid plastic water bottles that are

labeled “PC” (polycarbonate), or “7” recycling code. Beverages should be contained in reusable

food-grade stainless steel or glass bottles. Lastly, glass containers should be used to microwave

food because when plastic is used in the microwave, chemicals are released in the food

(Perlmutter & Loberg, 2015).


42

Exercise, Sleep, and Water

Exercise. Turner (2011) reported that an individual should exercise or engage in physical

activity on a regular basis. According to Leaf (2016), exercise improves cognitive function and

is important for memory development in children. Additionally, hormones that improve memory

and thinking are increased during exercise.

Sleep. Bongiorno (2012) noted that sleep is an important factor in maintaining a healthy

lifestyle. In fact, Leaf (2016) correlated lack of sleep with junk food cravings and weight gain.

Insufficient sleep interferes with the body’s biorhythms and could lead to an inefficient immune

system and an increase in cortisol (Bongiorno, 2012). Bongiorno suggested that the most

important step toward a proper night of rest would be to turn off all lights and electronic devices

30 minutes before bed and be in bed by 10 P.M.

Water. One of the important functions of water is to transport tryptophan to the brain to

maintain proper serotonin levels (Bongiorno, 2012). As previously discussed, the brain is about

2% of the body; however, the brain will use half of the calories ingested throughout the day.

Since our brain is made up of 78% water, drinking water is an important action step in taking

care of the body (Bongiorno, 2012). For example, if the brain does not receive enough water, the

middle brain areas work harder, which causes stress to the body. Bongiorno suggested that an

individual should drink at least half of the body weight in ounces of water every day.

Nutrition

There are several steps to take to promote a healthy lifestyle (Turner, 2011).

• The first step is to reduce the number of daily calories consumed by reducing the amount

of processed and refined foods and increasing the amount of fresh, natural foods

(Perlmutter & Loberg, 2015; Turner, 2011).


43

• The second step is to eat at least five half-cup servings daily of pesticide and herbicide-

free fruits and vegetables spanning the color of the rainbow (Perlmutter & Loberg, 2015;

Turner, 2011). This will maximize antioxidant and polyphenol intake (Turner, 2011).

• The third step is to incorporate whole grains, which are a great source of antioxidants,

certain B vitamins, minerals, and fiber (Turner, 2011).

• The fourth step is to cook with the wide array of spices and herbs, which provide flavor

to food and increase antioxidant intake (Turner, 2011).

• The fifth step is to eat at least two servings per week of fatty fish (salmon) and eat grass-

fed meats, consume raw nuts, seeds, and their oils on a regular basis (Turner, 2011).

When shopping for these foods, it is important to choose locally grown organic food as

much as possible, as this will help maximize overall nutrient intake (Turner, 2011).

• The sixth step is to eat a balance of protein, fat, and carbohydrate at every meal and

snack, as this helps balance blood sugar and neurotransmitter function (Turner, 2011).

Program Supports

Richards and Sindelar (2013) emphasized that due to the rise of obesity, specifically in

the western world and with low-income households, policymakers are looking at how programs

can guide people toward making healthier food choices. One of these programs within the U.S.

that is utilized by low-income households is the Supplemental Nutrition Assistance Program

(SNAP). SNAP is a federally funded welfare program administered by the United States

Department of Agriculture (USDA) with a goal to increase the ability for low-income

households to access food to prevent starvation or malnutrition. Changes within USDA

programs include taxes on sugary food items such as sugar-sweetened beverages, restrictive

regulations, and guidance toward healthier food options. Guidance toward healthier food


44

options, or making healthier food options more accessible, provides positive motivation to

change unhealthy eating habits (Richards & Sindelar, 2013).

Discussion

The purpose of this review was to gain insight into how mental health and nutrition are

related in a bidirectional manner. More specifically, to raise awareness of how eating a

nutritious and balanced diet can reduce anxiety, thereby reducing or eliminating the need for

pharmaceuticals. The research reviewed for this project revealed that food has a direct impact on

mental health. This is a result of how food directly affects the gut microbiota, which in turn

directly affects the immune system, and ultimately the brain.

Acquiring information on what types of foods a client consumes will assist mental health

practitioners in understanding the client in a holistic manner, gaining more insight into the

current client struggles. This information can be acquired from the client by conducting a

lifestyle assessment in the first several sessions of therapy (Powers & Griffith, 2012). Also,

utilizing Adlerian concepts to understand a client can result in a greater awareness of the client’s

goals and lifestyle.

Implications for Practice

Based on the literature reviewed for this project, it is more than likely that those suffering

from a mood disorder, such as anxiety, will have unhealthy eating habits due to the high stress

hormone levels and the impact on gut health. The information that has been discovered on the

gut-brain axis and the impact on mental health should alert practitioners to become educated on

this topic. Undergraduate and graduate level psychology programs should consider

incorporating a required health class related to the gut-brain axis. Also, an awareness of this


45

field of study should be shared with practitioners around the world. In addition, practitioners

should gain an awareness of their own health, as it effects the work with clients.

Raising the client’s awareness regarding the benefits of eating locally grown, organic,

fresh, natural foods should be considered as part of the therapeutic process, as eating healthy has

a profound impact on mental health. The utilization of medications to treat symptoms may be

necessary; however, it may not always be the answer. Understanding the role of proper nutrition,

in coordination with stress-reducing activities such as exercise and meditation should be

considered when attempting to treat mental health symptoms such as depression and anxiety.

The lifestyle assessment (Powers & Griffith, 2012) is a useful tool to discover what a

person eats, how well he or she sleeps, and the amount of physical activity every day.

Understanding how a person takes care of themselves will give insight and context as to how the

therapist can facilitate mental health. Once the information from the lifestyle assessment is

gathered, the therapist can review with the client and formulate specific tools that will be

beneficial in supporting the client’s needs. For example, the therapist may create a list of

recommendations for the client.

Bongiorno (2012) listed various recommendations that could help foster changes when an

individual suffers from a mood disorder. These recommendations can be utilized in the

therapeutic environment, providing an additional tool for the therapist to use when working with

a client who has expressed challenges in mood stabilization. Recommendations include

nutrition, water, sleep, and exercise.

Nutrition:

▪ Eat small meals throughout the day, including snacks

▪ Eat breakfast


46

▪ Consume fresh vegetables, fruits, nuts, lean meats

▪ Stay away from processed foods as much as possible

Water intake:

▪ Drink half the body weight in water every day (e.g., 80 ounces for a 160-pound

individual)

▪ Start the day with one large glass of water

Sleep:

▪ Go to bed by 11 p.m. and get seven to eight hours of sleep each night

▪ Put away all electronics 30 minutes before bedtime

Exercise:

▪ Move the body every day

▪ Take 25-minute walks three times a week

Recommendations for Future Research

Based on the research reviewed in this project, a recommendation for future study could

include the educational system and the ability to promote awareness of the gut-brain axis and the

impact on mental health. First, researchers could gain insight regarding nutritional programs

currently found within the school system. Next, researchers could review the different

educational programs and determine where they could begin to implement education regarding

the gut-brain axis. As a result of the research, program development could occur based on the

information acquired from the research.

The brain-gut axis is fairly new research and limited peer-reviewed articles discuss this

relevant topic. As the research on this topic continues, there will more than likely be new

discoveries on the gut-brain axis and advances in treatment. When the new discoveries on the


47

gut-brain axis are provided, continued focus should be given to the bidirectional relationship

between mental health and nutrition.


48

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