If you're just joining us, I highly recommend you start by reading Part 1 and Part 2 before jumping back into this post!

If you've followed along with parts 1 and 2, let's recap: so far we've talked about what postpartum depression is, how it is impacted by lifestyle factors (like untreated mental illnesses in pregnancy, physical activity, sleep, social isolation, stress, and skin-to-skin care), how hormonal changes impact mood (including estrogen, progesterone, thyroid, and cortisol, all of which change dramatically during pregnancy and postpartum), and some of the nutritional factors at play (including omega-3s, vitamin D, choline, zinc, iron, and amino acids). 

Today, we're going to tackle one of the weirdest parts of the story--the gut microbiome--and something that comes up so often these days that you're probably actually sick of talking about it--inflammation.

And then, because this is going to be our last post in this series, we'll take a few moments to try to put it all together into a dietary pattern that you can actually follow. (Hint: it's about adding things, NOT about restricting.)

The gut microbiome
I’ve been nerding out on the gut microbiome for years now, and I’m constantly amazed by how much we’re learning about it and how much we really just don’t know about it. (If anyone tells you that they really understand the gut microbiome, they’re spinning a yarn.)

One thing that we do know is that it’s not static. It’s always changing and adjusting.

During pregnancy and in the postpartum period, recent research has found some interesting changes which may be linked to postpartum depression. Stress, changes in hormone levels, and changes in diet are just a few of the factors that might lead to changes in the gut microbiome, which in some cases could be substantial enough to create dysbiosis—an imbalance of healthy/harmless and pathogenic gut bugs. Dysbiosis, then, can lead to changes in the way that we process the nutrients we eat.

• For example, dysbiosis can change production of neurotransmitters like serotonin and melatonin.
• Dysbiosis can lead to increased inflammation, both in the gut itself and in the brain.
• We also know that the gut microbiome produces compounds called short-chain fatty acids when the microbes break down certain food components like fiber. Butyrate, for example, is an anti-inflammatory compound important to the health of our gut lining integrity. Some research suggests that having fewer butyrate-producing bacteria in our guts may be associated with more mental health symptoms like anxiety and depression.
• The gut microbiome also seems to play a regulatory role with adrenal function and cortisol, the stress hormone we discussed before. Dysbiosis could lead to overproduction or underproduction of cortisol, either of which could be detrimental to our mental health.
• And lastly, the gut microbiome plays a role in modulating estrogen and progesterone levels, which could be really helpful in that postpartum period of plummeting estrogen levels.

To treat an unhealthy or imbalanced gut microbiome postpartum, throwing probiotic supplements at the problem could be slightly helpful, but doesn’t have a ton of supportive evidence yet. On the other hand, eating a varied diet with lots of colorful plant foods and fibers to feed your gut bugs, and consuming probiotic foods such as kimchi, sauerkraut, kefir, natto, and tempeh, has a potential to benefit you even more broadly.

Inflammation and neuroinflammation (and gestational diabetes)
Let’s move on to talk about inflammation. It’s important to note that levels of inflammation fluctuate a LOT during pregnancy and in the early postpartum period. The first and second trimesters are largely anti-inflammatory, but then the third trimester, childbirth and early postpartum are generally pro-inflammatory.

While studies aren’t conclusive, there is some early evidence that postpartum depression, like certain forms of major depressive disorder, may be more likely to occur in individuals with higher levels of inflammation postpartum. If that does bear out, it makes a lot of sense that some of those anti-inflammatory nutrients we discussed before (like vitamin D, fish oil, and zinc) would be some of the most helpful nutritional interventions. It also brings the relationship between the gut microbiome and gastrointestinal inflammation into a new light, and sheds some light on the relationship between gestational diabetes and postpartum depression, as well.

Having gestational diabetes during pregnancy is linked to an increased risk of postpartum depression. At the same time, having a history of depression makes you more likely to experience gestational diabetes during pregnancy. These two conditions are very interrelated.

There are higher levels of inflammatory compounds in the blood of women with gestational diabetes. Plus, the abnormal processing of sugar that occurs in women with gestational diabetes can lead to elevated stress hormone levels and so to mood symptoms. All that on top of the sense of psychological stress that women may feel due to the pressures and challenges of dealing with a disease like gestational diabetes.

So if we use what we know about preventing gestational diabetes as a jumping-off point for preventing postpartum depression, how do we prevent and manage gestational diabetes?

• Lifestyle factors are certainly important, like quitting smoking and getting enough physical activity.
• Eating an anti-inflammatory, perhaps Mediterranean-style, low-glycemic index diet with lots of plants (fruits, vegetables, nuts, seeds, pulses, and healthful oils) and some carefully-selected animal foods.
• Preventing deficiencies (especially B12, folate, vitamin D, and iodine).
• Inositol, perhaps? Once known as vitamin B8, inositol was demoted from its status as a B vitamin once we discovered that our bodies produce it from glucose. It’s also widely available in food, as well as supplemental form. However, it is still hugely important in metabolic health and can help with hormone regulation and anxiety. When pregnant women eat low-fiber, plant-deficient diets, they’re also eating diets that are low in inositol. So this is perhaps yet another reason to eat more plants, to help boost inositol intake and improve glucose metabolism in the body. Studies looking at supplementing inositol have found some reduction in risk of gestational diabetes, especially for women in larger bodies.

Putting the pieces together
We’ve covered a lot of ground in this series of articles together, from gut health to inflammation to nutritional adequacy to hormones to lifestyle. So what kind of eating pattern would help us the most with all of these factors we’ve discussed?

The list is nothing earth-shattering:

• Vegetables,
• Fruit,
• Fish (especially cold-water, low-mercury fatty fish) and sea vegetables (and/or taking an EPA+DHA supplement),
• Eggs,
• Minimally processed meat,
• Nuts and seeds,
• Pulses (lentils, beans, peas),
• Whole grains,
• Olive oil (and perhaps other anti-inflammatory oils such as unadulterated avocado oil, minimally processed rapeseed oil, etc.),
• Fermented foods, including fermented vegetables/beans and fermented dairy (like yogurts and kefirs) if tolerated, and
• Spices and herbs.

Alongside this nutrient-dense and flavorful food, we’re aiming for a healthy and enjoyable relationship with our food, and focusing on rhythms rather than rules and restrictions. We’re aiming for a lifestyle that is active, but also well-rested (again, as much as is possible during these phases of life) and social support that helps us get time for self-care and nurturing relationships. These are, in many cases, the truly difficult things. I’m here to try to make the eating part as simple as possible—to support you as you work to support your body and mind with healing and nourishing food.

If you’ve learned something from this article series, I’d love to hear about it! If you’d like to learn more about working with me, click here for details and to book a free discovery call, or shoot me an email.