Physician Outlook

Addiction And The Gut….

Is There A Connection?

Twenty-five years ago, when I was in the Drug and Alcohol field as a clinician, my first job out of college, we did not have all the tools, tests, research, and information we have today. Our diagnostic capabilities were written on the pages of a published manual. Our intakes checked the box for family history, current and past behavior and in rare cases, if a patient had been hospitalized for an overdose or for psychiatric reasons, we would have access to the treatment summary as well.

But we did not look at the diet. We didn’t have the sophistication of genetic testing or information from the Human Genome Project. We didn’t look deeply into the brain with powerful scans or do neurotransmitter testing. We did not know about leaky gut, or food intolerances or how inflammation impacts thoughts and behavior. And when we look at current findings from genetics, the gut microbiome, the brain, and addiction, we now have many more pieces of the puzzle to shed light on some of the underpinnings of addiction, relapse, and recovery.

Researchers believe there may be a connection between the health of our gut microbiome and addiction. In recent years research has established a connection between the gut and the brain and have identified the many ways in which they communicate. This communication pathway is known as the gut-brain axis and extends from the esophagus to the anus.

Your gut contains approximately 500 million neurons and your brain contains 100 billion neurons. These neurons send biochemical signals to “talk to each other” and influence how the body responds, expresses genes and self-regulates. The vagus nerve is a cranial nerve that influences the parasympathetic control of the heart, lungs, and digestive tract and sends signals in both directions.

Gut-Brain Modulation and the Impact of Inflammation

The gut-brain axis is modulated by hormones, bacteria, cytokines, foods, and neurotransmitters and influences the overall health of the gut. More than 90% of the body’s serotonin, 50% of its dopamine and the neurotransmitter gamma-aminobutyric acid (GABA), which helps control feelings of fear and anxiety, are all synthesized in the gut. It is believed that poor gut health may contribute to anxiety, low mood, learning and memory challenges and overall cascade of inflammation that can lead to leaky gut, IBS, SIBO, Candida, food intolerances, gas, and bloating… these chronic conditions are known to change the gut flora, impact signaling molecules, and affect how we absorb nutrition from the foods we eat. The amount of inflammation will influence our ability to think clearly, have energy, and enjoy both physical and mental health.

In addition, inflammation and changes in gut microbiome have also been studied in people with mental illness. Bipolar, anxiety, depression and psychotic disorders can also arise from conditions related to the function of the immune system and gut health. Much of our immune cells also reside in the gut.

The Role of Genetics

Both human and animal studies support this idea that healthy gut bacteria can help regulate mood, energy, brain function and behavior. In fact, science is currently looking at the influence the gut microbiome may have on addiction and addictive behaviors. Looking at markers for motivation and reward dynamics, how stress can impact the gut, and overall genetic markers for addiction and other disorders may help us uncover how people who struggle with alcohol and drug addiction may exhibit shared patterns in unhealthy gut flora and gut/brain communication.

Several genes have been associated with addiction. In fact, the National Institute on Drug Abuse (NIDA) has funded studies to explore the role both genetics and the microbiome has on substance abuse. In 2015, it was estimated that almost 21 million people, 12 and older, suffered from alcohol and drug abuse and another 27 million people reported using illicit drugs. Family studies that have included twins, siblings and those who were adopted, suggest that as much as half of a person’s risk of becoming addicted to nicotine, alcohol, or other drugs is greatly influenced by genetic makeup.

Gut Health and Relapse in Alcoholics

Research also suggests that bacteria in the gut may play a role in alcohol addiction and the likelihood of relapse after rehab. Alcohol addiction is often associated with an imbalance of gut flora. In fact, one study found that 26 out of 60 alcoholics suffered from leaky gut syndrome and had low amounts of the critical bacteria known as Faecalibacterium prausnitzii, which is known for its anti-inflammatory properties. Leaky gut syndrome has been linked to inflammation and diseases like Crohn’s disease, food allergies, asthma, and arthritis. After 19 days without alcohol the 26 alcoholics with leaky gut still scored high on tests that measured depression, anxiety, and alcohol cravings.

By contrast, 34 subjects with normal gut flora recovered faster, measuring lower on the same tests. In fact, their scores decreased to levels comparable with a control group who did not have a drinking problem.

Putting the Pieces Together: A Comprehensive Look

One of my doctors always says “test, don’t guess.” We now have comprehensive testing for the brain, and we can evaluate the health of the gut where many signaling molecules, hormones, neurotransmitters, and nutrients are produced or governed. We can look at our genetics and our genetic markers and put together a comprehensive view of how our mind and body functions and as we learn more about the intricacies of addiction and how all of these body systems are related, we can do more to treat addiction. Recovery isn’t about pure willpower or determination, it’s also about what’s going on inside the body - the systems and organs that impact and influence mood, behavior, reward and mindset. Many clinicians have been implementing some of this testing and as we continue to learn more, treatment for addiction will become more sophisticated and comprehensive. 

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