You may have heard that inflammation is a root cause of chronic diseases like diabetes and heart disease, but did you know there’s also a well-established link between chronic inflammation and mental health symptoms?

Mental health illnesses are very common in the United States and across the globe. It’s estimated that over 20% of American adults have one, but this number is probably much higher if you consider those who suffer from mental health symptoms without seeking help. Traditional treatment options can provide some relief, but they may not address root causes like inflammation. Fortunately, there are many therapies we can use to target inflammation, which may lead to more complete healing.

So, let’s dive into how chronic inflammation can impact mental health symptoms and the lifestyle-based therapies you can use to improve outcomes. 

[signup]

What is Chronic Inflammation?

The inflammatory process is an innate survival mechanism. When you have an injury or come into contact with an invader (like a bacteria, virus, or other pathogen), your immune system gets to work, sending out inflammatory messengers to neutralize the threat. Once this acute inflammatory response is completed, the body returns to its normal state of homeostasis, and all is well. Acute inflammation is pretty easy to spot, and often, you’ll have redness, swelling, and pain in an affected area.

Another type of inflammation, chronic inflammation, is not as easy to detect. In this situation, inflammatory mediators continue to be released despite not being needed. This ongoing assault can damage your tissues and organs, ultimately leading to disease symptoms like chronic fatigue, poor sleep, joint and muscle pain, weight fluctuations, mood changes, digestive distress, and frequent infections. Chronic inflammation is thought to be a contributing factor to many chronic diseases, including mental health illnesses like depression, anxiety, and cognitive decline. 

There are a variety of contributing factors that can lead to chronic inflammation. Some of the most common causes include aging, poor digestion and gut dysbiosis, inflammatory diets and excessive alcohol intake, hormonal imbalances, metabolic factors like obesity and diabetes, smoking and other toxin exposure, chronic stress, poor immune system function, and sleep disorders. 

Chronic Inflammation as a Root Cause

Chronic inflammatory diseases (CIDs) are the leading cause of death worldwide. CIDs can progress over time, all the while silently damaging every organ system in the body. Research has found chronic inflammation to be a significant root cause of numerous diseases like cardiovascular disease, autoimmune diseases, diabetes, cancer, asthma, chronic obstructive pulmonary disease (COPD), and chronic kidney disease. But research also shows chronic inflammation as a root cause of mental health issues like depression, anxiety, Alzheimer’s disease, bipolar disorder, and schizophrenia.

In the case of mental health symptoms, epidemiological evidence has shown a significant link between mental health disorders and immune-related illnesses, which points to inflammation as a significant factor. For example, there seems to be an increased risk of psychosis in those with various autoimmune disorders, and people with autoimmunity may have a 45% increased risk of schizophrenia. In addition, high levels of proinflammatory cytokines have been found in those experiencing their first episode of psychosis, but these inflammation markers are significantly lower when mental health symptoms are in remission. Another data point that suggests chronic inflammation as a root cause of mental health disorders is the improvement patients with mental health symptoms experience when taking anti-inflammatory or immune system-modulating drugs. 

Functional Medicine Labs That Can Help Evaluate Chronic Inflammation and Mental Health

Inflammatory markers can be helpful for identifying patients with inflammation, but they don’t always pick up low-grade, chronic inflammation. Since inflammation may be the result of food sensitivities, poor digestive function, dysbiosis, and nutrient deficiencies, functional medicine labs that assess these causes may be helpful for developing treatment plans for patients with mental health symptoms that are related to inflammation.

Food Sensitivity Testing

Food sensitivities may be a culprit when it comes to chronic, low-grade inflammation. The Array-10 Multiple Food Immune Reactivity Screen may help identify sensitivities, which can be important for personalizing the meal plan. This Cyrex Laboratories test is a blood test that looks for IgG and IgA antibodies to food proteins. 

SIBO Testing

Intestinal dysbiosis can contribute significantly to low-grade inflammation via increased intestinal permeability (leaky gut). The SIBO 3-Hour Breath Test by Genova Diagnostics measures gasses (hydrogen and methane) in the breath, which may be indicative of small intestinal bacterial overgrowth (SIBO). Practitioners can personalize the treatment plan to target SIBO, reducing the immune system burden and inflammation. 

Micronutrient Panel

The Micronutrient Test by SpectraCell Laboratories can help to determine if there are any nutrient deficiencies that are contributing to chronic inflammation. Practitioners can use this information to tailor the meal plan or for targeted supplementation to improve nutrient levels. 

Comprehensive Stool Testing

Since poor gut health, dysbiosis, and maldigestion can contribute to chronic, low-grade inflammation, a comprehensive stool test, such as the GI-MAP by Diagnostic Solutions, identifies imbalances and other digestion-related issues and can help providers tailor a plan to improve gut health.

[signup]

Psychoneuroimmunology: Bridging the Gap

It makes sense that the central nervous system (CNS) and the immune system are connected by a flow of information to protect the body and the brain. The field of psychoneuroimmunology (PNI) studies this connection and how altered immune system function and out-of-control inflammation can impact the brain, leading to mental health symptoms. So, how does chronic inflammation affect the brain?

It was previously thought that the blood-brain barrier (BBB) protected the brain from what was going on in the rest of the body. But we now know low-grade inflammation (and immune-related mediators) from the periphery can indeed cross the BBB to impact the brain. This can result from the transmission of pro-inflammatory cytokines from the periphery via the vagus nerve and through the activity of the brain's own immune cells, called microglia.

Microglia are responsible for normal brain function, but they're also a first line of defense against infections or insults that need to be removed in order to protect the brain. When an invader is detected, the microglia (and other immune system-associated cells) upregulate inflammation and recruit immune mediators from the periphery. This inflammatory cascade can alter the production and availability of neurotransmitters like serotonin and dopamine. And if the microglia continue the inflammatory assault, the risk of psychiatric and neurodegenerative disorders increases.

Mental Health Implications

‍Mental health encompasses a person’s social well-being, as well as their psychological and emotional health. Mental health status impacts everything from relationships with other people and the ability to maintain employment to self-care and disease risk. Conventional treatments may not always address the root causes of poor mental health, so patients can be left with poor quality of life and increased risk of other chronic diseases and suicide. Since prolonged inflammation can lead to mood and behavior changes, as well as poor cognitive function, it’s essential to design treatments that take this root cause into consideration. Here are a few mental health conditions related to chronic inflammation.

Schizophrenia

Patients with schizophrenia may have genes that promote neuroinflammation, but environmental stressors and altered immune system function are also intimately tied to disease development. Altered blood levels of pro-and anti-inflammatory mediators, changes in CNS volume, and altered microglial activation have been confirmed in patients with schizophrenia. It’s possible that stress, aging, and neurodegeneration cause microglial activation, leading to an extreme immune system response in the CNS, resulting in behavioral alterations.

Depression

Some patients with depression (approximately 30%) have been found to have higher levels of inflammatory markers such as IL-6, TNF-α, and CRP. Elevations in these markers seem to exist before patients develop depression symptoms. In addition, brain studies done on victims of suicide with known depression have shown altered microglial activation.

Depressed patients with fatigue, sleep disturbances, and the loss of pleasure or interest in normal activities may have chronic low-grade inflammation as a root cause. Further evidence that inflammation may underlie some forms of depression is a randomized controlled trial that found treatment-resistant depressed patients with high inflammation markers who were given an anti-TNF agent improved significantly over depressed patients who didn’t have elevated inflammatory markers. 

Anxiety

Patients with posttraumatic stress disorder (PTSD) have higher blood levels of IL-6, TNF-α, and CRP, but the research is mixed on other anxiety disorders. While patients with generalized anxiety disorder have been found with higher levels of CRP, other types of anxiety disorders like obsessive-compulsive disorder, panic disorder, and social anxiety don’t seem to have higher levels of inflammatory markers. However, stressful events and trauma are known to increase hypothalamus-pituitary-adrenal axis (HPA-axis) reactivity and stimulate the immune system to release proinflammatory mediators, which could play a role in the pathophysiology of anxiety disorders.

Inflammation Modulating Lifestyle Interventions

An anti-inflammatory lifestyle for mental health can potentially reduce the need for prescription medications or make them more effective and allow patients to recover more fully. Let’s take a look at why diet, exercise, sleep, and stress management can be such powerful interventions when it comes to lowering the inflammation that may contribute to mental health symptoms.

Anti-Inflammatory Diet

Diet may be one of the most important drivers of chronic inflammation in the body since it can have a direct impact on levels of oxidative stress, the immune system, and the gut-brain axis. People who follow an anti-inflammatory diet (like the Mediterranean diet) tend to have fewer issues with depression and cognitive decline, and this type of eating style has been found to lower proinflammatory markers, like IL-6. An anti-inflammatory diet may provide it’s benefits by lowering oxidative stress, improving blood sugar regulation and immune system function, and improving the gut microbiome profile. 

Contrast that with a diet that’s high in ultra-processed foods, refined grains, sugar, inflammatory oils, and alcohol, which can lead to blood sugar dysregulation, intestinal dysbiosis, and leaky gut, all factors that can lead to or exacerbate mental health symptoms. 

Leaky gut occurs when there’s a loss of barrier function in the small intestinal lining. This barrier interruption (from diet, food sensitivities, environment, stress, medications, and/or dysbiosis) can allow large food particles, toxins, and microbes to cross into the systemic circulation, stimulating the immune system to upregulate inflammation. This inflammation can impact the gastrointestinal tract but can also make its way to the brain to create neuroinflammation.

An anti-inflammatory diet can help lower inflammation and normalize gut barrier function, removing a significant burden from the immune system. There are many options when it comes to an anti-inflammatory diet. Generally, it’s a meal plan centered around fruits, vegetables, whole grains, fish and lean meats, healthy fats, nuts, beans, and legumes. 

Exercise 

Being sedentary is linked with poor mental health and cognitive decline. A well-rounded exercise routine that includes resistance training, flexibility exercises, and aerobic training can help to improve the health of the gut microbiome and lower intestinal inflammation. Aside from its impact on the gut, exercise can also enhance total body inflammation levels, increase brain-derived neurotrophic factor (BDNF), promote healthy levels of neurotransmitters, and increase nutrients and oxygen to the brain, which all work to improve mental health symptoms. Consistent exercise may prevent anxiety and depression, as well as improve symptoms in those with schizophrenia. And many well-designed research trials have found exercise to significantly reduce the symptoms of depression.

Sleep 

Sleep disturbances are common among those with poor mental health, and circadian disruption may be one factor leading to gut dysbiosis, inflammation, and leaky gut. In addition, people with poor sleep tend to have higher levels of inflammation markers like CRP, IL-6, and fibrinogen. Prioritizing healthy sleep can help lower inflammation, improve quality of life, and make sticking with other healthy lifestyle changes easier for patients with mental health symptoms.

Stress

Chronic, unmanaged stress is closely tied to immune system dysfunction and chronic inflammation. Patients with PTSD have higher levels of inflammatory markers, and those with autoimmunity (a disease of inflammation) are known to have a dysregulated stress response. Various stress management techniques like mindfulness and yoga have been found to lower inflammatory markers and improve mental health symptoms.

Therapeutic Approaches and Interventions

While conventional approaches to mental health symptoms may be beneficial for some, when it comes to those with out-of-control inflammation, they may not provide complete healing. It’s important to use all the tools in the toolbox when creating therapeutic interventions for inflammation-induced mental health issues. Dietary supplements, mindfulness techniques, and cognitive behavioral therapy may all be helpful.

Supplements

Dietary supplements can be part of a comprehensive treatment plan to target inflammation. Omega-3 fatty acids can reduce inflammation, improve HPA-axis function, and enhance neuroplasticity. Probiotics work to rebalance the gut microbiome to lower inflammation, improve immune system function, and increase BDNF. Saffron and cannabidiol preparations may help to lower inflammation and oxidation. Ginger can modulate the immune system and limit inflammatory pathways, and turmeric can down-regulate proinflammatory mediators.

Meditation/Yoga

Since HPA-axis dysfunction is closely linked with inflammation, educating patients on how to promote the ‘rest and digest’ state with mindfulness techniques can help to lower the stress response, restore normal immune system function, and lower inflammation. Meditation and yoga have been shown to improve inflammatory markers, digestive and immune system function, and mental health symptoms.

CBT

Cognitive behavioral therapy (CBT) is a commonly used form of psychotherapy for depression and other mental health disorders. CBT helps patients learn how to reframe negative thought patterns and to use coping skills effectively. A systematic review found CBT to be associated with reductions in at least one inflammatory marker in many trials but not across the board for all patients. 

[signup]

Summary

Inflammation is a root cause of many chronic diseases but is also an underlying factor for mental health conditions like depression, anxiety, and schizophrenia. Higher levels of inflammatory markers and altered immune system function in people with mental health symptoms may be a result of chronic stress, sleep and gut dysfunction, and other lifestyle-related factors.  

Conventional treatments like medications and CBT can be very effective for some people with mental health symptoms. However, since prolonged inflammation can be a contributing factor, a comprehensive plan that targets inflammation with diet, supplements, exercise, sleep, and stress management may help patients achieve greater relief from mental health symptoms.