Is my mental well-being affecting my vitiligo?
“You have vitiligo” – those words draw the blood from your face and the floor from beneath you. Wondering where and why it started. Is there a cure? As with many life-changing diagnoses, it can leave you feeling like your world has suddenly fallen into disarray before you start to digest things. Like the motions following grief – shock, despair, acceptance – building a relationship with yourself – for what feels familiar in your newfound skin is a process, which surely weaves many emotional states.
It’s certainly been my own personal experience and one I see in the clinic time and time again. Not necessarily in a bad way – but in a different way. Forming a new relationship with a diagnosis, no matter what that might be, takes time and trust. Trust in yourself as well as work towards challenging those self-limiting beliefs. A transitional time that can be bumpy to say the least.
There are many factors leading to autoimmunity. Genes certainly hold 30% of this responsibility, however environment, diet, and stress, preclude to the propagation of many disease states including, but not limited to, vitiligo. Looking back at my experience now as a clinician, I often find when listening to the detail, there’s a moment of realisation which joins the dots – in actual fact, yes, life suddenly changed after vitiligo, however it certainly wasn’t an easy ride prior to that. We know this because as with most disease states, stress certainly is the driver, if not a trigger for autoimmunity.
For me, I recall my final year pressures at university twined with grief from losing my gran, which triggered a wave of buried emotions from my earlier childhood memories – losing my father, the person I regarded as my superhero. Learning not to speak about the pain was an easier way to cope, pretending to be strong so I could go visit him in hospital upon his final days, and feeling isolated because very little spoken about grief during that time. All of which built up walls as a coping mechanism over the years which suddenly came crashing down when I faced grief again when granny died. Although, in this instance, the passing of granny could be celebrated as she lived a long and healthy life, my body interpreted this loss as the one I faced at aged 12. Whilst I thought I felt like myself and was relatively healthy, my immune system signalled otherwise. It’s what we now recognise as learnt behaviour from childhood patterns which then become the coping mechanism of running the hamster wheel and distracting ourselves from our emotional state in order to carry on. A narrative, which feels so familiar to many, and a narrative, which will not be unfamiliar to those to come.
Our bodies are a synergy of complex systems communicating with each other in a sophisticated manner, more then we could possibly imagine. It relies on the right resources to function, repair, perform and restore. We can’t cheat its needs or cheat it into believing it’s “fine”. Chemical exchanges and pathways will always outweigh what we tell ourselves. Whilst having optimism and a positive mindset is part of healthy well-being, this differs from denial and telling ourselves we are ok when we also recognise we are not. Suppression of emotion will always be an expression upon our health. When we manage this, we manage to project and perform healthy lifestyle measures to actually live the life we choose, one that is not determined by our diagnosis.
Keeping the mind in mind
The relationship between food, mood and anxiety is gaining more and more attention and for good reason. All physiological processes are vital when optimising cognitive function. The bio-chemicals found in food have a profound effect on several complexes in our body but here I’m focusing on the relationship between the gut-brain axis and its immune modulating effect.
The human body is inhabited by a wide variety of commensal microorganisms collectively called the microbiota. There has been a substantial amount of evidence and funding finally being funneled into the role of nutrition and its relationship with our gut microbiome. The ZOE study is the largest experiment to have taken place following Covid investing in the science behind the power of nutrition for disease prevention and making huge advances in our knowledge. We know the gut microbiome is extremely important for our innate immune system, our body weight, metabolism, and importantly brain health. The findings continue to prove that simply changing our diet has a direct and profound effect on the microbiome, with an incredible ability to change our microbiome in a very short space of time, as short as a few days!
Let’s talk microbes in our gut
There is strong clinical research on not only the correlation of probiotic use in autoimmunity, including vitiligo, but also the positive effects of probiotics upon mental health issues like depression and anxiety. The gut-brain axis can be modulated by whole foods and probiotics. We require not only the macro nutrients from protein, fats and complex carbohydrates but also, importantly, the micronutrients which act as catalyst’s in order for exchanges to take place. Without co-factors, nutrient depletion and insufficient uptake can take effect. Any interference with our hormones and neurotransmitters without the required nutrient intake, can lead to depression and anxiety. Factors certainly are multifactorial, however poor diet has a huge steering factor. Starving our cells of the nutrients needed can deplete productivity in performance and repair.
To geek out a little, the main metabolite in our colon is short-chain fatty acids (SCFAs), produced by bacterial fermentation of dietary fibers and resistant starches – both found in plant-based foods. Its key role is neuro-immunoendocrine regulation. A network of cells signal regulation in order to maintain balance within our body with neurotransmitters, hormones and cytokines. Cytokines are small proteins which are crucial in controlling the growth and activity of other immune system cells and blood cells. When released, inflammation – including neuroinflammation – takes place, affecting anxiety and mental health.
SCFA can be inhibited by the western diet as it lacks fibre. The significance of dietary foods through plant foods is not to be underestimated. The role of SCFA in the regulation of neuro–immunoendocrine function is important and has been compromised by the western diet and modern-day stresses. The western diet is low in fibre and high in protein, unhealthy fats, food additives, sugar, and processed salt – all of which impact the inflammation, especially of the intestinal mucosa, prominent in autoimmunity. If this is disrupted and porous, it compromises the conversion of SCFA which can impact autoimmunity by either switching on predisposed genes to offset the activation of autoimmunity or can drive autoimmune symptoms to consistently remain in a “flare”. Furthermore, neurotransmitter balance is negatively impacted attributing to mental health challenges, obesity, cognitive impairment, anxiety all of which further drive systemic inflammation, including neuroinflammation.
Symptoms of disrupted mucosa membrane can express as (but not limited to): anxiety, depression, allergies, food sensitivities, digestive problems and bowel irregularity, infections, brain fog and immune dysregulation.
Mindful eating for the raw materials to making neurotransmitters
In order for our neurotransmitters to regulate, they need precursor co-factors. We obtain these from a whole food diet.
NeurotransmitterRequired Co-factorsObtained fromDopamine (feel good, pleasure neurotransmitter), adrenaline and noradrenaline (our excitatory, stress hormone)Amino acid – tyrosine or its precursor phenylalanineOrganic eggs, fermented soya, organic poultry, fish and seeds – especially sesame and pumpkin. Serotonin is a key hormone in stabilising mood, feelings of well-being, and happiness. Allows brain cells and nervous system to communicate with each other aiding with sleeping, eating, and digestion. Amino acid – tryptophanOrganic eggs, fermented soya, fish, pumpkin, sesame seeds, beans and pulses, game and red meat. Glutamate, GABA. Glutamate is the major excitatory neurotransmitter in the nervous system. Linked to many other neurotransmitter pathways, including glutamate receptors found throughout the brain and spinal cord neurons. Glutamine, and methionineComplete protein: Fish Organic eggs Tempeh tofu or natto Combining: beans and wholegrains to form a complete protein – if tolerated. Acetylcholine – Chief neurotransmitter of the central nervous system. Plays a vital role in motivation, arousal, attention, learning, and memory. Involved in promoting REM sleep. Choline (An essential component of the neuron membranes) Lack of choline in the diet has been associated to memory loss, poor skeletal muscle function.Organic egg yolk, fish roe, organic liver and lecithin granules.
Furthermore, we require co-factors in order for enzymes to act as catalysts to then convert raw material into neurotransmitters. The below are key for the gut-brain axis.
 Ljudmila Stojanovich,Stress and autoimmunity,Autoimmunity Reviews,Volume 9, Issue 5,2010,Pages A271A276,
 Clapp, M., Aurora, N., Herrera, L., Bhatia, M., Wilen, E. and Wakefield, S., 2017. Gut Microbiota’s Effect on Mental Health: The Gut-Brain Axis. Clinics and Practice, 7(4), pp.131-136.
 Manzel, A., Muller, D., Hafler, D., Erdman, S., Linker, R. and Kleinewietfeld, M., 2013. Role of “Western Diet” in Inflammatory Autoimmune Diseases. Current Allergy and Asthma Reports, 14(1).
 Mu, Q., Kirby, J., Reilly, C. and Luo, X., 2017. Leaky Gut As a Danger Signal for Autoimmune Diseases. Frontiers in Immunology, 8.
Co-factorsFunctionObtained fromB VitaminsPlay a major role in maintaining functioning brain chemistry. Deficiency in B vitamins is common in depression and anxiety. B vitamins: Green leafy vegetables are the best form of folate. The bioavailable form of B12 is in animal form so it is important for vegans or plant-based individuals to have their blood profile monitored. B12 deficiency contributes to depression as does low folate. Omega-3 fatty acidsOmega-3 fatty acids form an integral part of neuronal cell membranes and influence a number of essential processes in the central nervous system. A lack of omega 3 fatty acids in implicated in many cognitive and mood disorders. The western diet is high in omega 6 which is pro inflammatory. Whilst we need both omegas 3 and 6, they need to be in ratio. Without these essential fats, cell membranes cannot anchor the receptors, which results in disengaged cell-to-cell communication and inflammation.Oily fish, S.MA.S.H (salmon, mackerel, anchovies, sardines, herring) chia seeds, walnuts, soy beans – if tolerated. Organic eggs, hemp seeds, spinach – although in lower amounts.Vitamin CAs well as being a co-factor in immune and skin health, vitamin C is involved in the regulation and modulation of neurotransmitter biosynthesis as well as supporting the nervous system. Fruits and vegetables, especially yellow peppers, papaya, guava, citrus kiwi, strawberries, broccoli, brussels sprouts, potato, peppers, salad greens.ZincPresent for the conversion of serotonin in both the gut and brain as well as other neurotransmitters. Most abundant mineral in the brain. Low levels have been associated with depression and ADHD.Meat, game, fish, seafood. Nuts, seeds and seaweed.IronCrucial for structure and function of the central nervous system. Responsible in the synthesis and signaling of neurotransmitters dopamine, noradrenalin, adrenaline and 5-hydroxytryptamine (5-HTP), which are involved in emotion, attention, reward, movement. Lean meat, liver and darker meat. Oily fish, organic eggs. Beans, pulses, dark green leafy vegetables and dried fruit. Iron is better absorbed when consumed with foods rich in vitamin C.CopperIntegral and necessary for brain-specific enzymes that control neurotransmitters. Soy, oysters, shiitake mushrooms, sesame and sunflower seeds, cashews, brazil nuts and hazelnuts.MagnesiumTouted for its benefits, magnesium is involved in over 300 chemical exchanges in the body including the regulation of neurotransmitters, which send signals throughout the nervous system and brain. Essential in nerve transmission and neuromuscular conduction. Lightly cooked swiss chard spinach, kale, squash, pumpkin seeds, steamed broccoli, halibut nuts and seeds.CalciumReleases neurotransmitters from the site of the synapse assisting in cell-to-cell communication. If uptake of calcium is low in the brain, it will leach it from the bones, so is vital to keep this within a healthy range.Organic green leafy vegetables, fermented soy, mung beans, almonds, brazil nuts, flaxseed, sesame seeds, chia seeds. Organic dairy milk (if tolerant).
The Vagus nerve
Whilst your gut and brain are housed in different parts of the body, they maintain more than just a biological connection. They are actually connected by the Vagus nerve, also known as the “wanderer nerve” – taken from its Latin name. The Vagus nerve penetrates the gut wall, however its key role is to signal between the brain and gut in both directions.
The stimulation of vagal fibres in the gut plays a crucial role in major psychiatric conditions, such as mood and anxiety disorders. In line with this, there is preliminary evidence that gut bacteria from SCFA has a beneficial effect on mood and anxiety, partly by affecting the activity of the Vagus nerve
Since, the vagal tone is correlated with the capacity to regulate stress responses, it can be influenced by breathing, hence it’s tone can be strengthened through vocal activities, meditation and yoga, which contribute to resilience and mitigation of mood and anxiety symptoms.
Stimulate your Vagus nerve by:
Sleep is probably the single most health promoting activity one can apply to their life. It promotes repair, reduces inflammation, promotes longevity and regains neuroplasticity – which once was considered impossible. It is the most important factor in supporting our immune system, especially in autoimmunity, chronic conditions and mental health disorders. We should aim for 7-8 hours of sleep for adults and 9-12 hours for children. 
Research continues to show exercise reduces inflammation and improves health, including mental health conditions. Excitingly, recent studies show that exercise promotes a diverse community of microbes that contribute to the biodiversity of the bacteria in the gut. Exercise appears to be a potential external influence with the capacity to also support the alteration of the gut microbiome in a positive way. Exercise alterations to the gut microbiome may provide a link to the exercise-related benefits on gastrointestinal (GI) function, mood, and higher cognitive function in the brain centres.
Top 5 foods to avoid
Foods which cause oxidation, consequently speeding up the ageing process:
Blackened and overcooked meats and fish.Trans-hydrogenated and oxidised fats.High intake of intensively farmed meat and dairy foods.All processed foods, especially those labelled with ingredients you can’t pronounce!Sugars including added sugar – fruit juices, alcohol, and wine. Recreational drugs and white starches including white pasta, rice, breads and crackers.
Check in with yourself
Are you stressed?Are you sleeping enough?Are you exercising enough?Are you over-exercising?Are you drinking enough water?Are you eating a whole food diet?Are you sleeping enough?Are you doing things to calm the nervous system down – self-care?Do you have a good support network?Are you consuming fermented foods or probiotics?
 Young, L., Pipingas, A., White, D., Gauci, S. and Scholey, A., 2019. A Systematic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress: Effects on Healthy and ‘At-Risk’ Individuals. Nutrients, 11(9), p.2232.
 Simopoulos, A., 2002. Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases. Journal of the American College of Nutrition, 21(6), pp.495-505.
 Silva, Y., Bernardi, A. and Frozza, R., 2020. The Role of Short-Chain Fatty Acids From Gut Microbiota in Gut-Brain Communication. Frontiers in Endocrinology, 11.
 Breit, S., Kupferberg, A., Rogler, G. and Hasler, G., 2018. Vagus Nerve as Modulator of the Brain–Gut Axis in Psychiatric and Inflammatory Disorders. Frontiers in Psychiatry, 9.
 Dialogues in Clinical Neuroscience, 2008. Sleep disorders as core symptoms of depression. 10(3), pp.329-336.
 Dalton, A., Mermier, C. and Zuhl, M., 2019. Exercise influence on the microbiome–gut–brain axis. Gut Microbes, 10(5), pp.555-568.
 Dalton, A., Mermier, C. and Zuhl, M., 2019. Exercise influence on the microbiome–gut–brain axis. Gut Microbes, 10(5), pp.555-568.