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Weak immunity affects compliance
An imbalanced immune system, has long been known to negatively influence mood conditions including anxiety, OCDs and depression. Patients treated with drugs that suppress the immune system or suffering from deficiency in the immune response are more likely to show adverse changes in mood and behaviour. In addition, several factors increase the risk of imbalanced immunity, and thus mood and behavior, includes gut microbiome, age greater than 65, increased body fat, malnutrition, smoking, pregnancy, dementia or stroke, living in a nursing home, and special medical conditions. The composition of the gut microbiome is altered throughout the life course in response to dietary components, environmental factors including drugs. Alteration of the gut microbiome has significant impact on the immune system, as well as, mental implications, especially when highlighting the gut-brain axis and mental health. The above-mentioned factors are present in the majority of clinical cases seen by dietitians and other healthcare professionals in clinics. The mental cause to that incompliance might go unnoticed in the majority of cases, which may result in a burnout of the dietitian and a status of frustration by the patient.
Signs to suspect weakened immunity include high levels of stress, frequent colds & infections, recurrent GI problems, slow wound healing. These signs could be valuable in suspecting an imbalanced immune system, which could be the under-lying cause of a mental imbalance troubling patients and thus their cooperation with dietitians. Many lifestyle interventions exists to boost the imbalanced immunity including counseling on sleep hygiene, meditation and fostering for appropriate nutritional interventions and exercise. 
Among the effective nutritional interventions, biotics have a momentous role, particularly that they have exhibited a positive impact in regularizing the microbiome, which in turn plays an important role on immunity and in the gut-brain axis structure. Accordingly, biotics confer mental health benefits through interactions with commensal gut bacteria through regulation of varied and important physiological processes, including immunomodulation, adiposity and energy balance.