Category Archives: gut flora

Functional Medicine: Getting to the Root Causes of Illness, A cure for Alzheimer’s

Today I watched a great TED talk by Dr. Rangan Chaterjee discussing his own journey in the discovery and implementation of a functional medicine approach to caring for his patients. The concept of using basic science and clinical science to diagnose and treat the root causes of illness, rather than treating symptoms, has been around for more than two decades.  This approach has recently started to attract more attention, especially within the community of younger physicians who have become more dissatisfied with the frustrations of traditional allopathic medicine.

Here is the talk. Dr. Chatterjee covers lots of ground in a passionate and informative talk.

Enjoy this talk. If you would like to learn about how a functional medicine approach can CURE ALZHEIMER’S DISEASE then watch this video of Dr. Bredesen who gave this lecture at a meeting of the American College of Nutrition.

Doctor Bredesen, an acclaimed neuroscientist, researcher, and more recently a brilliant clinician, has been criticized by the academic research community for implementing a clinical research protocol that addresses more than one variable at a time! Unfortunately, medical science has been handcuffed by the drug-model of clinical research wherein only one variable (drug vs. placebo for example) is studied. But if an illness has many potential contributing root causes, changing only one variable is doomed to failure, as Dr. Bredesen explains in this lecture.

Sleep well, eat clean, get outdoors every morning to help keep your circadian rhythm and biological clock in order.

Bob Hansen MD

Roundup and GMOs, are dangerous to your health and threaten the future of family farms in America

There is a brief discussion of Roundup (Glyphosate) on Medscape.

Our Toxic World; Is Roundup Slowly Killing Us?

The discussion covers several important issues. To Pique your interest in reading further here are a few salient quotes.

Glyphosate is the most used herbicide in the world, the pride and joy (as well as a great cash cow) of mega-giant chemical manufacturer Monsanto. Although ubiquitous as Roundup® and generally presented for many decades as safe for humans and animals, in 2015 The International Agency for Research on Cancer (IARC) of the World Health Organization labeled glyphosate as “probably carcinogenic to humans.”[3]

The European Union (EU) is trying to determine whether Monsanto should have its license to sell Roundup renewed this year. With that renewal in mind, in the spring of 2016, 48 members of the EU Parliament, representing 13 nations, volunteered to have their urine tested for glyphosate. All were found positive by a German lab.[4] In May 2016, a University of California, San Francisco, lab working for The Detox Project, funded by concerned individuals, reported positive urine tests for glyphosate in 93% of 131 urine samples from across the United States.[5]

Is this widespread presence of glyphosate in humans incidental and harmless or are we all in danger of being poisoned by this Monsanto product? That is a very good question.

Remember the gut microbiome? We are learning a great deal about how it influences so much of human health. There is a project called Qmulus, at the Computer Science and Artificial Intelligence Laboratory at the Massachusetts Institute of Technology and funded in part by Quanta Computers of Taiwan. Under its auspices, authors Anthony Samsel and Stephanie Seneff, in a 40-plus-page review[6] with 286 references, paint a very troubling picture of glyphosate’s inhibition of cytochrome P450 enzymes. For example, one role of this enzyme is to detoxify xenobiotics. The authors propose that the consequences of this inhibition, when coupled with other synergistic disruptions, may insidiously induce many diseases associated with a Western diet, including diabetes, obesity, cancer, autism, Alzheimer’s, and others.

A 2015 paper[7] by the same authors takes these and new findings and deductions even further to manganese deficiency in cows fed genetically modified Roundup Ready feed. This update is 55 pages long with 328 supporting references. Both are in open access; peruse them if you choose. [Editor’s note: Links to the full text of these papers are included with the references.]

If you want to learn more about Roundup, GMOs, and the worsening global threat to our food safety (no exaggeration) you can learn more by visiting www.CenterForFoodSafety.org.

I learned about this organization while watching the film The Future of Food. Although this hit the screens in 2004 it is still worth watching. If you think ROUNDUP is safe or that GMO foods are OK, think again. At least give this movie and website a look before you settle back into contentment with Monsanto and all the other bad actors in the food-seed-pesticide industry making decisions that WILL destroy the ability of farmers in the US and possibly world-wide to use their own seeds.

Monsanto has genetically engineered and patented a suicide gene and placed it into all of it’s seeds (cotton, soy, corn) so that farmers must buy seeds EVERY YEAR. This seed produces crops whose seeds are sterile. If this seed is carried by wind, animals, or other common mechanisms, from Monsanto’s’ crops to non-GMO fields, the gene will hybridize with natural seed crops and after several generations render a majority of crops infertile.

Monsanto produces not just pesticides but pesticide resistant seeds that produce sterile crops. Monsanto is playing monopoly and quickly eliminating independent seed producers and destroying family farms that have every year used their own seeds which have been bred to thrive in the local environment of the family farm.

Other issues abound. Roundup resistant crops, eaten by American consumers, have high levels of ROUNDUP and other pesticides that have been demonstrated to cause tumors in > 50% of animals within 1 year. Monsanto only tested ROUNDUP for 3 months in animal studies and declared it safe. The USDA did not test it. The FDA did not test it. Government scientists and university scientists who expressed concerns were silenced by the economic power of this massive multi-national corporation.

When independent scientists published their alarming results (carcinogenesis), Monsanto used it’s financial resources to shut those scientists down. You can learn about this by watching The Future of Food or visiting www.CenterForFoodSafety.org.

Like big Pharma executives cycling between the pharmaceutical industry and the FDA, Monsanto executives and lawyers cycle in and out of the FDA and USDA. We have allowed the fox to guard the chicken pen and the stakes are high. Family farms have been put out of business by Monsanto’s unethical and predatory behavior, eliminating generations of private seed banks and wreaking havoc for family farms across America. Don’t believe it? Watch the movie. Many farmers have gone bankrupt fighting legal battles with Monsanto because the wind has blown Monsanto’s patented seeds onto their private lands and Monsanto successfully sued them for patent infringement. This predatory behavior has been going on below the radar for many years and it started when the Supreme Court ruled that Monsanto can patent seeds.

In fact, Monsanto has gone into the US national seed banks, collected samples of thousands of different seeds, and patented them! This outrageous and ridiculous scenario has allowed a private company to patent thousands of heritage crop seeds.

If this sounds incredible, you are right, but it is true.

In the meantime, support mandatory GMO labeling and support food retailers who have promised to carry only NON-GMO foods.

To your health.

BOB Hansen MD.

Chronic Pain Reduced by the Paleo Lifestyle

I spend 50% of my clinical time treating chronic pain patients. A paleolithic diet which consists of pastured grass-fed meat, free range poultry and eggs, fresh seafood, fresh vegetables, fruits and nuts decreases inflammation by eliminating major sources of dietary induced inflammation.

Yesterday I saw a patient one month after he started a paleolithic lifestyle (paleo diet, 8 hours of sleep per night- cycling with the sun, regular exercise including a prescribed spine rehab program).

Within 30 days his pain  has decreased by more than 50%, He feels  more energetic. He stated “I have started to dream again and get a full night’s sleep”. He has lost 12 pounds in one month and his blood pressure is down. He is ready to return to work after not working for eight months (with some activity restrictions). He is not taking any opiate pain medication.

His MRI scan and X-rays of the spine will not demonstrate any improvement. He still has degenerative disc disease, one or more tears in a disc annulus (outer wall of the disc) and arthritis in the facet joints of his neck (cervical spine) and lower back (lumbar spine). But the lifestyle elements that have contributed to his chronic inflammation have been significantly reduced in just 30 days and he has benefited “tremendously” in his own words.

There are many mechanisms involved with chronic inflammation. Most patients with chronic pain have an inflammatory component. Many patients with chronic pain are overweight or obese. Excess visceral adiposity (fat around the internal organs) creates a state of chronic inflammation by constantly producing inflammatory chemicals called chemokines and cytokines. These inflammatory mediators are produced by the fat cells and by the white blood cells (macrophages) that reside alongside the fat cells. They contribute to a process called central sensitization where the brain and spinal cord nerves that mediate pain  become sensitized and over-react to sensory input. Interleukin 6 is one of these mediators. Increased levels are associated with fatigue, depression and a state of hyperalgesia where painful stimuli are amplified. Tumor necrosis factor alpha is another important inflammatory mediator produced in excess when excess fat accumulates around the internal organs. Weight loss is essential to decease systemic inflammation, particularly in the setting of chronic pain when someone is overweight or obese.

Pro-inflammatory foods can also increase inflammation by altering intestinal flora and increasing intestinal permeability. These mechanisms have been discussed in previous posts and in the manifesto page of this website.

Few patients follow my dietary and lifestyle advice. Most seem to prefer taking pills, getting injections and other interventional pain procedures. In other words, they prefer to “be-fixed” rather than  take lifestyle initiatives that are likely to not only decrease their pain but also improve their general health. As an interventional pain practitioner I encourage patients to take full advantage of the pharmacology and interventional procedures that are likely to help. But without significant changes in bad dietary habits, poor sleep hygiene and without adopting a rehabilitation exercise program the pills and injections/procedures are much less effective and the prognosis is poor.

Stress reduction is also essential for health in general and for pain reduction in particular. Yet despite repeated recommendations to utilize an inexpensive stress reduction workbook, few patients ever bother to take this important step to reduce pain, anxiety and suffering.

Our culture is one in which patients expect to “be fixed” rather than to be led down a path which leads to healing and functional improvement by actively participating in their own rehabilitation and healing. Our culture is also one in which  major organizations provide bad dietary advice, particularly with respect to encouraging increased consumption of grains and legumes which have pro-inflammatory components and anti-nutrients. We evolved over a few million years without consuming grains, legumes, refined vegetable olis or dairy. Our evolutionary biology and physiology thrive when these foods, particularly processed foods are eliminated from the diet and we consume only those whole natural foods we have evolved to eat.

Modern medicine provides many remarkable drugs, surgeries and procedures that can be life saving and life altering. But application of this technology without addressing the fundamental determinants of health (proper nutrition, restorative sleep, judicious exercise, stress reduction, and restoration of circadian rhythm) yields much less benefit. Ultimately, unless we remove from our lives the destructive components of modern society and culture we cannot heal and instead continue to suffer from chronic degenerative diseases that cause pain, loss of intellect and loss of mobility.

No references tonight, just comments and reflection. References have been provided in previous posts.

Peace, health, and happiness.

Dr. Bob

The bacteria in your gut are essential to your health Part II, obesity, metabolic syndrome and dysbiosis

I have discussed the evidence linking the mix of bacteria in your gut (gut flora) to health and disease in Part I. The Bacteria in your Gut are essential to your health Part I | Practical Evolutionary Health

Today I will discuss the evidence related specifically to  obesity and metabolic syndrome (the constellation of obesity, insulin resistance, high blood pressure, and abnormal blood lipids). My discussion will follow closely the evidence and theory presented in research and review papers authored by Dr. Cani and colleagues. The first one is titled:

Gut microbiota controls adipose tissue expansion, gut barrier and glucose metabolism: novel insights into molecular targets and interventions using prebiotics.”

You can find the full text of this article here .

I have had the pleasure of corresponding with Dr. Cani by e-mail regarding her many publications investigating the relationship between gut flora, obesity, and metabolic syndrome.

“Recently, we and others have identified several mechanisms linking the gut microbiota with the development of obesity and associated disorders (e.g. insulin resistance, type 2 diabetes, hepatic steatosis).”

Explanation: The gut microbiota are the bacteria, viruses and other “bugs” that reside in our intestines. Insulin resistance can occur in various parts of the body, wherever insulin has an effect including fat cells, liver, muscle, brain. When higher amounts of insulin are required to achieve an effect this is called insulin resistance. In Type 2 diabetes, the pancreas is still able to make insulin but insulin is less effective in controlling blood sugar. In Type I diabetes the pancreas no longer produces insulin. Hepatic Steatosis means fatty liver disease. The liver accumulates fat and this can lead to cirrhosis, liver failure and death. Alcohol consumption can cause this but when alcohol is not involved this is called Non-Alcoholic-Fatty-Liver Disease (NAFLD). Our nation presently has an epidemic of not just obesity but also NAFLD. Evidence points to  excess carbohydrate consumption and excess consumption of vegetable oils (linoleic acid)  as contributing factors in NAFLD.  Carbohydrate restriction and consumption of saturated fat, particularly medium chain fats (as found in coconut) can protect against NAFLD. But the gut flora also play a role. The mechanisms involved are many.

“Among these, we described the concept of metabolic endotoxaemia (increase in plasma lipopolysaccharide levels) as one of the triggering factors leading to the development of metabolic inflammation and insulin resistance.”

Endotoxemia occurs when a toxin from certain kinds of bacteria circulates in the blood. This endotoxin enters our blood through our intestines under conditions in which the protective barrier of the intestines is compromised. The compromise of the intestinal barrier is variously referred to as ” leaky gut” or “increased intestinal permeability”. Wheat gluten-gliadin  causes increased intestinal permeability (especially in celiac disease) as can other plant lectins. In this discussion, the gut bacteria also contribute in the setting of “dysbiosis” (the beneficial effects of helpful bacteria are overwhelmed by the harm-causing bacteria when a healthy balance is not present)

Lipopolysaccharide (LPS) comes from the outer wall membrane of certain bacteria. Blood plasma is the liquid part of blood in which the blood cells circulate. So an “increase in plasma lipopolysaccharide” simply means that there is more LPS circulating in the blood. That is a bad thing. Depending on how much is circulating this alone can cause organ failure and death and is a major part of the physiologic changes involved in septic shock. But lower levels of LPS circulating in the blood can cause chronic low grade inflammation and insulin resistance. Obesity is associated with chronic inflammation and increased LPS circulating in the blood and being distributed to various organs where it wreaks havoc.

“Growing evidence suggests that gut microbes contribute to the onset of low-grade inflammation characterizing these metabolic disorders via mechanisms associated with gut barrier dysfunctions.”

“We have demonstrated that enteroendocrine cells (producing glucagon-like peptide-1, peptide YY and glucagon-like peptide-2) and the endocannabinoid system control gut permeability and metabolic endotoxaemia.”

That is a mouth-full. Over thirty different kinds of hormone producing cells have been found in the human intestine. These cells are called enteroendocrine cells. The hormones produced by these cells have many effects. You can find a great review of these cells and their effects here .

In Dr. Cani’s review article she describes how some of these hormones produced in the gut can increase intestinal permeability and allow more of the toxic, inflammation producing LPS to enter the bloodstream. But these hormonal effects are just part of the picture. Another part relates to endocannabinoids.

The  Endocannabinoid system in humans is complex and relates to hunger, satiety, energy metabolism, and yes gut permeability. Endocannabinoid refers to our internal (endo) production of cannabis like substances. Pot smoking people get the munchies because of the appetite stimulating effects of marijuana. But endocannabinoids have many other physiologic effects including the modulation of pain, mood, immune function and memory.

Dr. Cani describes in great detail the evidence supporting the roles that the gut flora play in influencing intestinal permeability mediated through the effects of various hormones and endocannabinoids. In animal and human studies changing the gut flora produces changes in these hormones and endocannabinoids which in turn can increase or decrease intestinal permeability and increase or decrease circulating LPS.

It turns out that specific  Prebiotics can produce growth of beneficial gut bacteria and through the series of steps outlined above, reduce inflammation in the body, improve blood sugar, improve insulin sensitivity, and decrease fat,

Oh, and similar to the endocannabinoid system, there is an “apelinergic system” in our bodies that also plays a role. If you want to read more about these systems you should read the original article and the other links below to related articles.

I have discussed in the past that fecal transplants have been used to treat the specific dysbiosis that occurs with C Difficile colitis. But fecal transplants have many potential beneficial uses.

The Fatlose 2 trial is presently studying the effects of fecal transplants on insulin resistance and related problems in human volunteers. I will let you know when the results are published, Studies conducted in rodents have demonstrated significant weight loss and improved insulin sensitivity when obese rodents receive fecal transplants from lean rodents.

In summary: dysbiosis represents an unhealthy mix of bacteria in the gut

  • dysbiosis causes increased intestinal permeability (leaky gut)
  • increased intestinal permeability leads to increased circulating LPS, which is bad
  • elevated levels of circulating LPS create a chronic state of inflammation which contributes to obesity and metabolic syndrome
  • the mechanisms that link dysbiosis to intestinal permeability include hormonal disruption (enteroendocrine cells) and the endocannabinoid system. Other mechanisms are also likely in play.
  • prebiotics and probiotics can mitigate dysbiosis, reduce intestinal permeability, reduce inflammation, and offer potential therapy for obesity and metabolic syndrome
  • fecal transplantation offers a potential for treatment for obesity and metabolic syndrome, research is underway

Our ancestors lived and evolved for a few million years prior to the relatively brief ten thousand years of agriculture and one hundred years of industrialization. The overuse of antibiotics in medicine and animal husbandry have contributed to dysbiosis. Other factors include stress, disruption of circadian rhythm, sleep deprivation. Cesarean delivery and avoidance of breast feeding conspire to dysbiosis. Processed foods feed unfriendly bacteria in our guts at the expense of beneficial bugs. Agricultural foods have introduced dietary lectins which also increase intestinal permeability and thereby contribute to chronic inflammation. The further we stray from our evolutionary niche, the more problems we experience.

This discussion just touches the surface of gut flora, dysbiosis, health and disease. We have yet to explore the gut-brain axis. Our gut and microflora communicate with and effect the function of our brain and other organs as well.

We will continue to explore health and disease from an evolutionary perspective.

Below are links to articles related to our discussion.

Peace, health and happiness.

BOB

Gut microbiota controls adipose tissue expans… [Benef Microbes. 2014] – PubMed – NCBI

Glucose metabolism: Focus on gut microbiota, … [Diabetes Metab. 2014] – PubMed – NCBI

Probiotics, prebiotics, and the host microb… [Ann N Y Acad Sci. 2013] – PubMed – NCBI

Crosstalk between the gut microbiota a… [Clin Microbiol Infect. 2012] – PubMed – NCBI

Gut microbiota and its possible relationship … [Mayo Clin Proc. 2008] – PubMed – NCBI

Enteroendocrine Cells: Neglected Players in Gastrointestinal Disorders?

Not all calories are the same.

The old school teaching about obesity went like this. Consume more calories than you burn and you gain weight. Consume less calories than you burn and you lose weight. Obesity is just a problem of self control. All calories are the same.

This way of thinking has been dis proven but still pervades many discussions.

Ample evidence supports the following facts that should be considered in choosing foods and mitigating the obesity epidemic.

  • High glycemic high carbohydrate foods and beverages such as bread, pasta, potatoes, crackers, chips, granola bars, breakfast cereal, soda, energy drinks produce a rapid rise in blood sugar and insulin levels, stimulate hunger, enhance further carbohydrate cravings, and drive people to overeat. Thus, what kind of food you eat affects how much you eat. (1,2)
  • High carbohydrate diets  result in decreased calorie burning (decreased metabolic rate) compared to high fat high protein diets. Thus, a diet with carbohydrate restriction not only limits hunger (improves satiety) but also results in burning more calories for the same level of activity and at rest. I have previously discussed weight loss studies that consistently demonstrate that carbohydrate restriction results in spontaneous reduction in caloric consumption. At the same time this approach results in burning more calories while you watch TV or go for a walk. (3)
  • The human body does not absorb all of the calories present in food. A higher % of the calories present in highly processed refined foods (which represent 70% of the American diet) are absorbed compared to whole unprocessed foods such as tree nuts. (4)
  • Whole foods, especially non-starchy vegetables, provide much more satiety producing fiber (non-starchy vegetables have five to seven times as much fiber compared to whole grain bread on a per calorie basis)
  • Food choices produce different effects on the gut flora. A diet consisting of whole hunter-gatherer type foods (grass fed meat, free range poultry and eggs, wild seafood, fresh fruits, vegetables and nuts) enhance and support the development of “good bacteria” in the gut. As discussed before , the gut flora have a major impact on the risk of obesity and other diseases.
  • High carbohydrate diets produce higher insulin levels.  Insulin results in conversion of carbohydrate into fat and storage of fat. Insulin inhibits the burning of fat. Carbohydrate restriction results in burning fat for energy.
  • The process of protein digestion consumes more calories compared to the digestion of carbohydrate. Protein has a higher  thermogenic effect compared to carbohydrate.

THE BOTTOM LINE: not all calories are the same. The quality of the food we consume affects our metabolic rate, our absorption of calories, how quickly we feel full and therefore how many calories we consume, and the mix of good bacteria and bad bacteria that live in our GI tract.

Good health, peace and tranquility to all

BOB

1. Fed Up Asks, Are All Calories Equal? – NYTimes.com

2. Changes in diet and lifestyle and long-term wei… [N Engl J Med. 2011] – PubMed – NCBI

3. Effects of Dietary Composition During Weight Loss Maintenance: A Controlled Feeding Study

4. Impact of Peanuts and Tree Nuts on Body Weight and Healthy Weight Loss in Adults

The Bacteria in your Gut are essential to your health Part I

Our human body consists of about 100 trillion cells but we carry about 1000 trillion bacteria in our intestines, that represents 10 times the amount of our own cells. (1) These bacteria are variously called our micro-flora, microbiome, gut flora, etc, along with viruses and other organisms that co-exist and co-evolved with us. Advances in rapid gene identification have enabled an explosion of knowledge related to our micro-flora, health and disease. We each carry an estimated 500 to 1000 different species of bacteria in our intestines and the balance/mix of these bacterial species can have profoundly positive or negative affects on our health. Patterns of micro-flora have been identified for a variety of human disorders including obesity, diabetes type I, several kinds of cancer and  inflammatory bowel disease to name a few. The issue of association vs. causation remains to be resolved but the beneficial and therapeutic effects of pro-biotics and fecal transplant (in rodent and human studies) in a variety of situations along with the observed deleterious effects of interrupting our micro-flora speak in favor of a causative or contributory role. (2) (3)

Accumulating evidences indicate that some diseases are triggered by abnormalities of the gut microbiota. Among these, immune-related diseases can be the promising targets for probiotcs. Several studies have proved the efficacy of probiotics for preventing such diseases including cancers, infections, allergies, inflammatory bowel diseases and autoimmune diseases. Lactobacillus casei strain Shirota (LcS) is one of the most popular probiotics, benefits of which in health maintenance and disease control have been supported by several science-based evidences.(2)

Early microbial colonization of the gut reduces the incidence of infectious, inflammatory and autoimmune diseases. Recent population studies reveal that childhood hygiene is a significant risk factor for development of inflammatory bowel disease, thereby reinforcing the hygiene hypothesis and the potential importance of microbial colonization during early life. (3)

Early-life environment significantly affects both microbial composition of the adult gut and mucosal innate immune function. We observed that a microbiota dominated by lactobacilli may function to maintain mucosal immune homeostasis and limit pathogen colonization. (3)

The human GI tract starts with the mouth and ends with the rectum. In between lay the esophagus, stomach, and intestines which consist of the duodenum, jejunum, ileum, and colon.

The surface area of the intestines equals that of a tennis court providing a huge area for absorption, digestion and interaction between our immune system and the micro-flora. This large surface area is the result of the intestinal micro-villi which produce an undulating surface resembling a series of peaks and valleys. The constant interplay between our immune system (4) and our micro-flora from birth to death along with the signaling and communication that occurs between our micro-flora and our nervous system (5,6,7) present two physiologic mechanisms for potential symbiosis (mutually beneficial interaction) vs dysbiosis (disease causing relationship).

Before birth the mouth, skin and intestine of the fetus is sterile. The first major introduction of bacteria to the infant occurs with birth  when the infant swallows bacteria in the mother’s birth canal and the infant’s skin becomes colonized by the mother’s bacteria. Infants born by cesarean section lack this initial exposure and they suffer increased risk of allergic and auto-immune disease (8). The rate of cesarean section in the US is now about 30 % and along with that increase there has been an observed increase in allergy, auto-immune and other diseases.

The second major addition to human gut and skin flora occurs with breast feeding and again breast-fed infants show decreased rates of allergy and auto-immune disease as well as decreased infections compared to bottle fed infants.

The interaction between the micro-flora and the immune system presents many complex relationships and interactions. Immune tolerance allows the immune system to recognize “self” and “friendly bacteria”  limiting the development of auto-immune disease and enhancing anti-inflammatory processes. At the other extreme recognition of “non-self”  allows for the recognition and disposal of “foreign” invaders such as infections or mutated cancer cells.

“The Old Friends Hypothesis”
Common organisms interact with dendritic cells in the GI tract, leading to increased maturation of dendritic cells. When there is interaction with these organisms again, the dendritic cells increase Treg maturation; not Th1 or Th2. This increases the baseline amount of anti-inflammatory cytokines, producing a Bystander Suppression. Another consequence of the increased number of mature dendritic cells is as they interact with self antigens, they increase the number Treg specific to these antigens. This is referred to as Specific Suppression. Together these two arms lead to tolerance of both self antigens as well as those of helpful gut organisms. (8)

Translation:  Treg or Regulatory T cells regulate the immune system and help prevent auto-immune disease and allergic reactions. Th1 and Th2,  T helper cells , on the other hand, increase inflammation and help our bodies defend against infection. The balance between Tregs and Th1, Th2 cells governs inflammatory responses.

Premature infants have an increased risk of a developing a very severe illness called necrotizing enterocolitis. Human studies have demonstrated significant risk reduction for this problem with the administration of pro-biotics to infants in neonatal intensive care units. (9)

Similarly, administration of pro-biotics during the first few years of life (to mother and child)  have been associated with decreased risk of eczema in children. While some studies suggest reduction of allergies and asthma in children, the regular use of probiotics remains undecided relative to preventing food allergies or asthma (10, 11).

Due to the recent exponential increase in food allergies and atopic disorders, effective allergy prevention has become a public health priority in many developed regions. Important preventive strategies include the promotion of breastfeeding and vaginal deliveries, judicious use of perinatal antibiotics, as well as the avoidance of maternal tobacco smoking. Breastfeeding for at least 6 months and introduction of complementary solids from 4-6 months are generally recommended. Complex oligosaccharides in breast milk support the establishment of bifidobacteria in the neonatal gut which stimulate regulatory T lymphocyte responses and enhance tolerance development…Perinatal supplementation with probiotics and/or prebiotics may reduce the risk of atopic dermatitis, but no reliable effect on the prevention of food allergy or respiratory allergies has so far been found. A randomized trial on maternal fish oil supplementation during pregnancy found that atopic dermatitis and egg sensitization in the first year of life were significantly reduced, but no preventive effect for food allergies was demonstrated. (10)

Thus birth by cesarean section increases risk and  breast feeding decreases risk of immune related problems (allergies, auto-immune disease and infection ). Use of probiotics for mother and child decrease the risk of eczema but the use of probiotics in preventing asthma or food allergy remains unsettled. There are a host of possible probiotics available that include various combinations of “healthy bacteria”. Future posts will discuss some of these.

Our micro-flora are constantly exposed to potential changing agents. Known influences include antibiotics (as medications or in the foods that we eat), stress, sleep, and diet. Because of the ubiquitous use of antibiotics in agriculture and animal husbandry, and the sometimes excessive use of antibiotics in medicine our microbiome is frequently changed by external factors. Many experts on the microbiome  consider these influences harmful and attribute the rising rates of several diseases as consequences of disruption in our gut flora.

Clostridium Difficile Colitis , a serious infection or overgrowth of the bacterium Clostridium difficile in the intestine occurs most commonly as a result of antibiotic administration to treat infections. This serious problem responds to anti-biotic treatment (ironically both the cause and cure) 90% of the time with the first round of treatment but there is a high incidence of recurrence due to the fact that C-difficile spores are resistant to antibiotics and can cause recurrent infection. In refractory or recurrent C-difficile cases a fecal transplant (FMT or fecal microbiota transplant) from a healthy human results in a 90 to 95% cure rate with the first treatment.

Antibiotic usage disrupts the normal gut flora and leads to an increased predisposition to CDI. The risk of recurrent CDI after initial treatment of the first infection is approximately 20–25% [Kelly and Lamont, 2008; Khanna et al. 2012g] and is further increased up to 60% with the use of additional systemic antibiotics and subsequent CDI recurrences [Hu et al. 2009]. The pathophysiology of recurrent CDI involves ongoing disruption of the normal fecal flora and an inadequate host immune response. Standard CDI treatment with antibiotics such as metronidazole and vancomycin further disrupts colonic microbial communities that normally keep expansion of C. difficile populations in check. Since C. difficile spores are resistant to antibiotic therapy for CDI, they can germinate to vegetative forms after treatment has been discontinued and lead to recurrent CDI. (12)

The authors of this study review the data for fecal microbiota transplant and summarize by stating:

Therefore, existing literature suggests that fecal transplant is safe and effective with over 500 cases of recurrent CDI with no serious adverse events reported to date. FMT appears to be an appropriate treatment option for multiple CDI recurrences and may be considered for refractory moderate to severe C. difficile diarrhea, failing standard therapy. The FDA had recently announced that an Investigational New Drug Application would be required for use of FMT for CDI, but this was later changed to the use of an informed consent process to ensure communication of potential risks.

In the area of obesity rodent studies have demonstrated that fecal transplants from thin to obese subjects results in significant weight loss. Measurable differences in the microbiome of obese vs thin humans have been identified.

The prevalence of obesity and related disorders such as metabolic syndrome has vastly increased throughout the world. Recent insights have generated an entirely new perspective suggesting that our microbiota might be involved in the development of these disorders. Studies have demonstrated that obesity and metabolic syndrome may be associated with profound microbiotal changes, and the induction of a metabolic syndrome phenotype through fecal transplants corroborates the important role of the microbiota in this disease. (13)

The issue of gut flora and obesity deserves a dedicated post. Multiple research articles and review articles have been published on the topic of fecal transplantation in relation to obesity, diabetes, metabolic syndrome, autoimmune disease and cancer. (14,15,16)

Diabetes, obesity, allergy, auto-immune disease, infections, psychiatric disorders and cancer represent examples of the potential interplay between the human microbiome, human health and disease. Multiple sources of information suggest a cause and effect relationship. The results of fecal transplantation in human and rodent studies, manipulation of the gut flora with pro-biotics and pre-biotics, data on the effects of vaginal vs cesarean delivery, and the benefits of breast feeding all proclaim the importance of our micro-flora.

Most traditional cultures have one or more forms of fermented foods. Examples include yogurt, kefir, sauerkraut, kim chee, beet kvass, kombucha. Almost any food can be fermented to produce health promoting probiotics and there is a growing movement for home-fermentation and/or consumption of purchased fermented foods. In addition to the pro-biotic nature of fermented foods and beverages, fermentation offers other potential health benefits. These include reduction of the anti-nutrients found  in various neolithic  foods (such as mineral binding phytic acid found in grains and legumes, digestive enzyme inhibitors found in soy and other legumes). Other potential health benefits include the production of Vitamin K2 found in many fermented foods.

This discussion barely scratches the surface of gut flora, health and disease. Future posts will address how our gut bacteria produce essential nutrients and affect mental health as well as physical health. Other important topics include how our activity, food, sleep and stress affect the our gut ecology. The system is dynamic with effects going in both directions.

Following the references below you will find links to NPR discussions of related topics. You can choose to read the articles and/or listen to the NPR interviews and reports.

Peace, happiness and longevity.

BOB

(1) Microbes in Gastrointestinal Health and Disease

(2) Probiotics as efficient immunopotentiators: Translational role in cancer prevention

(3) Environmentally-acquired bacteria influence microbial diversity and natural innate immune responses at gut surfaces.

(4) Has the microbiota played a critical role in the evolution of the adaptive immune system?

(5) It’s a Gut Feeling – how the gut microbiota affect… [J Physiol. 2014] – PubMed – NCBI

(6) Metabolic tinkering by the gut microbiome: Impl… [Gut Microbes. 2014] – PubMed – NCBI

(7) The gut-brain axis rewired: adding a functional vaga… [FASEB J. 2014] – PubMed – NCBI

(8) Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis.

(9) Probiotics for prevention of necrotizing enterocolitis in preterm infants.

(10) Preventing atopy and allergic disease.

(11) Gut microbiota and allergic disease: new findings.

(12) Clostridium Difficile Colitis ,

(13) Gut microbiome, obesity, and metabolic dysfunc… [J Clin Invest. 2011] – PubMed – NCBI

(14) Fecal microbiota transplantation: indications, methods, evidence, and future directions.

(15) Fecal microbiota transplantation: past, present and future.

(16) Therapeutic potential of fecal microbiota transplantation.

Here are the NPR and other links.

Interview: Martin Blaser, Author Of ‘Missing Microbes’ : NPR

FDA Backs Off On Regulation Of Fecal Transplants : Shots – Health News : NPR

Human Microbiome Project – Home | NIH Common Fund

Staying Healthy May Mean Learning To Love Our Microbiomes : Shots – Health News : NPR

Gut Bacteria Might Guide The Workings Of Our Minds : Shots – Health News : NPR

Worried That Your Baby’s Sick? There May Be An Upside : Shots – Health News : NPR