I saw a 34-year-old female this week who came in to speak to me about depression related to her miscarriage last year with her first pregnancy. No prior history of depression. Healthy medically except for your ureteral reflux as a child with a history of multiple UTIs and frequent treatment with Septra and other antibiotics growing up. As an adult, still gets recurrent UTIs and often postcoital. Also note from a functional perspective she developed an adult food allergy as shellfish and gets frequent migraines which may be food related. Can you help me connect some dots between the vaginal microbiome issues, UTIs, recurrent antibiotics, migraines, food allergies and depression? Has been prescribed gluten-free Paleo, more exercise, and doing standard labs but haven’t ordered food sensitivity or stool yet. Plan to order probiotics for mood based on stool culture results. Any thoughts on how to avoid future UTIs?

Chris Kresser: Okay. Yes, a lot here. This makes perfect sense to me. It’s a great example of the gut-brain axis and in this case the gut-brain-gonad axis. There is a growing amount of research that connects disrupted gut microbiome to disrupted vaginal microbiome, conditions that are associated with that—UTIs, disrupted nasal microbiome. We know now we have this whole body microbiome, and if the microbiome is disrupted in any one part of the body, that can actually transfer to other parts of the body. We also know that depression is. Some of the most recent thinking on depression is called the inflammatory cytokine model of depression, which holds that depression is an inflammatory disease that’s caused by inflammation usually in the gut. That makes perfect sense to me with the history of antibiotics and then potentially disruption. That happens with further disruption that might have happened with the miscarriage that that could potentially the disruption, and, of course, you have to consider a situational thing here. Miscarriage is a pretty traumatic event, and that could certainly lead to depression, so we don’t want to be reductionistic here and only think about the physiological mechanisms. I’m sure you are thinking about it already Tom, but I just wanted to point that out to be thorough. Migraines, I’ve definitely seen a big connection between gut disruption and migraines that can sometimes be mediated by histamine intolerance or histamine and tyramine intolerance, and that causes a kind of pro-inflammatory state, which can lead to food allergies and a whole bunch of other conditions as you know, inflammation being at the root of most modern and chronic disease.

I think your plan is good. I would definitely test for SIBO as well if you can. I think really focusing in on the gut here is what makes the most sense to me as well as any other emotional psychological support she needs related to the miscarriage. In terms of preventing and treating chronic UTIs, fixing the microbiome is the best way to focus on that in my experience. But again, there’s an article that we wrote way back in 2012 actually. If you search for “Kresser prevent UTIs,” there’s a bunch of really good suggestions in there, and that on top of addressing gut health can be really helpful.