Mind Over Inflammation: Gluten sensitivity
I know that this is going to be a pretty unbelievable read, but it is true.
The bottom line is this. For the past 10 years, I have had recurring tendonitis, which inhibited my ability to work-out with weights, and eventually forced me to stop playing guitar. One day, for a reason that is unknown to me, I decided to go gluten free. None of my tests had been positive, but I decided to give it a shot. Lo and behold, I was cured. I tested myself on and off gluten several times, and my conclusion held true. I was never quite sure whether it was gluten, yeast, or both, but if I had gluten, within 20 minutes my symptoms would appear, and there was no mistake about it. In fact, as many people report, my sensitivity seemed to get more severe over time; the time between my food misdemeanor and the pain shrunk more and more. So I was careful, although not extreme, to avoid both. Within weeks, I picked up my guitar again (still not up to speed on the weights though, but getting there). So far, most people will agree that there is nothing shocking about this story.
Now, on a parallel track, about 10 years ago when this all began, I became involved in a highly stressful situation, which was resolved several months ago, with tremendous relief. Now here is the interesting part: My gluten sensitivity is gone. Not just somewhat, but completely gone. My nails, which had developed ridges, have returned to their condition at age 40 or so. So, here is a case of a clear sensitivity to a dietary substance, with very significant symptoms which cleared with the elimination of a major psychosocial stressor.
Now, if I were reading this, I would say:
“Well of course, we know the mind affects the body. If any one should know this, it would be you Dr. Hedaya. Didn’t you create Whole Psychiatry?”
My answer is, well, yes, we do all know this. But do we really KNOW this? Do we really ever think that a disease will clear if we clear the psychosocial factors? Can physiology change that much?
Frankly, I am shocked, despite my years of teaching the psychobiological science, psychoneuroimmunoendocrinology (PNIE) at Georgetown. The science goes like this:
Social Defeat or Helplessness→ increased limbic activity (emotional brain, amygdala)→ hypervigilence, and anticipation of adversity→ increased sensitivity to pain→ reduced PFC (prefrontal cortex, executive function) activity→disturbed HPA [hypothalamic-pituitary-adrenal] function→reduced levels of adrenal corticosteroids→increased levels of inflammatory cytokines→ infection, insomnia, fatigue. (1)
Of course there are lots of off-shoots from this basic model, such as the nearly immediate (changes occur in minutes) effect that an episode of emotional hyperarousal has on the balance between gut bacterial colonies (the good and the bad colonies together are called the microbiome), and the ‘leakiness’ of the gut. When the gut gets leaky, substances such as gluten, sneak into the blood stream by slipping between the cells lining the gut (e.g., the small intestine). The immune system, standing guard to stop these terrorist molecules, calls up the troops (immune cells), which shoot their bullets (antibodies, cytokines etc) to stop the invaders in their tracks. Unfortunately this little war happened every time I ate gluten/yeast, because my gut was leaky on a more or less continuous basis (because of hyperarousal), and so it resulted in an inflammatory response which left me, the host country literally limping.
Looking at it through this lens, it makes perfect sense that resolution of my social defeat/learned helplessness, would change all the downstream results which I experienced. Yet, it still amazes me. It reminds me of the story of the three blind men and the elephant. One, touching the elephants tusks, described the elephant as smooth and hard. The second touching the skin, described the elephant as thick and rough, while the third, rubbing his hand across the elephants ear, described the elephant as thin and fuzzy. The lesson of the story? To understand what an elephant is, you just might have to live with one. To know the power of the mind over inflammation, you just might have to change the way you live.
Slavich, GM., Irwin, MR: From Stress to Inflammation and Major Depressive Disorder: A Social Signal Transduction Theory of Depression.
Psychol Bull. 2014 May; 140(3):774-815.