Microbial Ecosystem Health Reflects Societal Health

            Venezuela faces a dire health situation currently.  In addition to a widespread famine, the crashed economy resulted in the inability of the country’s drug companies to produce or purchase raw ingredients to make any drugs at all.  Additionally, the government lacks the funds to attract business from foreign drug manufacturers like Pfitzer and Bayer to import drugs.  Hospitals all over Venezuela therefore lack any sort of medication or equipment to treat any ailment, from various types of pain to mental health disorders.  These include mental health clinics and hospitals, which must release as many of their patients as possible.  The patients released, untreated and without medication, often pose a risk to themselves, others, or both.

            The burden of care and supervision for these individuals falls on their families, who already face a drastic food shortage in the country as well.  Those who may have contributed to Venezuela’s labor force now must stay at home to supervise these dangerous patients, and a dwindling labor force means the economy falls further into the hole.  It’s a dangerous cycle that appears impossible to break out of. 

            For the patients who do not have a family to take them in, the burden falls to chronically stressed staff, who without food or medication to give their patients, must rely on physical restraints to keep their patients from suicide or harming other patients.  Their workdays consist of hearing cries of agony that include pleas for food and of ramblings from those who experience voices in their heads telling them to kill.  What little food there is to give is not humane either, bugs crawling in sewage and rotten fruit found in the dirt.

            To make matters worse, the current government allegedly turned down multiple offers for foreign aid (Casey, 2016).  The situation seems dire, but there is no way to say for sure because the government has not made public any sort of statistics of citizen health since 2010, according to the Associated Press (2013).  There seems to be no end in sight for the plight of the Venezuelan citizens.

            Food, or lack thereof, is an important detail in this anecdote to describe the magnitude of the mental health issues Venezuela faces in particular.  Diet and health both physical and mental are undoubtedly connected, and in many ways that are still not yet discovered.  It is known that individuals (e.g. diabetics) who experience low blood sugar can result in a variety of symptoms, which may include impaired judgment and personality changes, which can lead to inappropriate behaviors (i.e. criminal actions.)  Several other links have been explored between food intake and well being both mental and physical.

            For instance, a study of fecal flora in late-onset autism in children compared to their normal and healthy counterpart found that there was a disproportionate ratio of several bacterial belonging to more than one genus.  In particular, several species of the genus Clostridium were found to be on average three times more prevalent than the control children (Finegold et al, 2002).  Several studies explored this potential therapeutic target and found that in some cases children treated with probiotics showed not only improved gastrointestinal health, but lesser severity of neurological symptoms associated with autism (decreased repetitive behaviors, decreased anxiety with less structure, etc.).  However, more research needs to be conducted to either support or contest the idea of introducing this treatment as a mainstream therapy for autism (Umbrello & Esposito, 2016.)

            The main idea behind all these studies is looking into links between gut microbiota and mental health follows the theory that functions of the brain and the activities of the symbionts living in our gut are intricately connected.  Many other connections between various other conditions are being explored, such as with Parkinson’s disease, various allergies, asthma, Crohn’s disease, multiple sclerosis, symptomatic atherosclerosis, and even autoimmune diseases (Thakur et al. 2014.)

            Diet and physical health are connected, as we all know, and taught as a whole field, nutrition.  But only within the last decade or two, a new link involving the balance of the various types of the inhabitants of the gut has garnered attention.  After all, what else are these symbionts supposed to live on but the food that the host eats? 

            What the host eats dictates the dynamic of the gut flora and the effects circle back again to the host.  In one study, mice that were treated early in life with a low dose of broad-spectrum antibiotics (referred to as a sub-therapeutic dose) became much heavier and fatter than their non-antibiotic treated control counterparts due to increased bone density and increased adipose tissue levels.  Upon further examination, hormones known to control appetite and satiety levels were the same in both groups, and short-chain fatty acid (SCFA) concentration in the experimental mice were elevated.  This implies a few things about these mice with artificially altered microbiota.  Firstly, this increased SCFA concentration indicates an increased rate of metabolism and metabolic efficiency in their gastrointestinal symbionts since these macromolecules are a result of microbial digestion of otherwise indigestible substance (by the host) such as cellulose.  It is known that SCFAs are a main food source for intestinal epithelial cells, but also stimulates the liver to increase the rate of lipogenesis, thus increasing fat content.  These findings are especially applicable to American diets because they lack fiber and include an excess intake of carbohydrates, which naturally alters the composition of the intestinal ecosystem in similar ways to the mice mentioned earlier with sub-therapeutic antibiotics.

            This increased emphasis on a more biological approach to frame such conditions such as obesity can lead to alternative and possibly more effective forms of treatment.  One such case that shows promising results is a new approach to weight loss (and possibly other behavioral-based conditions), which is referred to as “acceptance based therapy” or ABT.  In experimental groups undergoing ABT as a treatment, additional counseling was provided to emphasize the biological role behind the cravings for fatty and sugary foods, so any cheating on a diet is not due to a “lack of willpower” in many cases, hopefully reversing the effects of that negative stigma.

            ABT appears to work in prevention as well.  One of the researchers responsible for formulating ABT conducted another rather cruel study which involved giving a bunch of undergrad students a transparent box full of chocolates and then told the students not to eat them, but to carry them around with them at all times for two days.  Groups were given different treatments; one group received a more traditional distraction-based and cognitive reassurance therapy, one group received counseling by ABT as mentioned above, and the third control group was not given any sort of intervention during this time.  Of course, success of each group’s ability on resisting eating the chocolate depended on their baseline scores on the Power of Food Scale (PFS), which is the test the researchers used to quantify results.  However, there was a clear difference of success rates of groups with the interventions compared to the control group, with the ABT group doing better overall (Forman et al. 2007).

            Yet, the whole idea that an individual could undergo acceptance-based therapy still requires the patient to have a baseline level of security enough to think about these biological mechanisms underlying their ailments.  Applying the ideas behind Maslow’s hierarchy, it follows that when there is uncertainty of safety of either self or others close enough to feel responsible for, these therapies have no value and are not effective.

            Which brings me back to the opening anecdote about Venezuela’s health situation. This insecurity brought about by Hugo Chavez’s policies resulted in inflation that’s about 500%, according to NPR’s Planet Money (2016).  And concerning disconnect between the Venezuelan citizen and their government, there exists great insecurity not only about safety from the released mental health patients, but also about the chronic food shortages within the country.  Now, these are not claims that without a food shortage or paranoid schizophrenics wandering the streets there would be none of these issues in Venezuela, nor are these attempts to propose any one solution to fix the hole that this country is in.  This is simply attempting to further explain a possible reason why the health crisis in Venezuela is so bad.  Unfortunately the problem here is too great for any one person to fix.

Works Cited:

Bajak, Frank. “Doctors say Venezuela’s health care in collapse.” The Big Story.             Associated Press., 6 Nov. 2013. Web 26 Oct. 2016.

Casey, Nicholas. "At a Loss for Meds, Venezuela’s Mentally Ill Spiral Downward."        New York Times. N.p., 1 Oct. 2016. Web. 3 Oct. 2016.

Finegold SM, Molitoris D, Song Y, Liu C, Vaisanen ML, Bolte E, McTeague M, Sandler   R, Wexler H, Marlowe EM, Collins MD, Lawson PA, Summanen P, Baysallar M,           Tomzynski TJ, Read E, Johnson E, Rolfe R, Nasir P, Shah H, Haake DA,    Manning P, Kaul A. 2002; Gastrointestinal microflora studies in late-onset             autism. Clin Infect Dis. Vol 35:S6–S16.

Forman, EM, KL Hoffman, KB McGrath, JD Herbert, LL Brandsma, MR Lowe. 2007. A comparison of acceptance- and control-based strategies for coping with food       cravings: An analog study.  Behavior Research and Therapy Vol 45:2372-86.

Smith, Robert and Noel King. “How Venezuela Imploded” Planet Money. NPR. 21 Oct             2016. Web 26 Oct. 2016.

Umbrello G and Esposito S. 2016. Microbiota and neurologic diseases: potential        effects of probiotics. Journal of translational medicine. Vol 14:298