Mary I Butler

The microbiota‐gut‐brain axis (MGBA) has been the subject of much research over the past decade, offering an exciting new paradigm for the treatment of psychiatric disorders. In this review, the MGBA is extended to include skeletal muscle and the potential role of an expanded “muscle‐gut‐brain axis” (MuGBA) in conditions such as anxiety and depression is discussed. There is evidence, from both preclinical and human studies, of bidirectional links between the gut microbiome and skeletal muscle function and structure. The therapeutic role of exercise in reducing depressive and anxiety symptoms is widely recognised, and the potential role of the gut microbiota‐skeletal muscle link is discussed within this context. Potential pathways of communication involved in the MuGBA including the tryptophan‐kynurenine pathway, intestinal permeability, immune modulation, and bacterial metabolites such as short‐chain‐fatty‐acids are explored.