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Health

The world inside…

We humans, each of us, have trillions of microbes that live inside and on the surface of our bodies – most experts say about 4 pounds worth. These include over 10,000 different types of microbes (including bacteria, viruses, and fungi), collectively known as our “microbiome”. And having a larger variety of microbes in our system may actually be a protector against future illness, as new research suggests they give us resilience against disease.

For many years we only heard about bad bacteria, viruses and fungi that cause disease. But the truth is, most organisms are beneficial, and, in fact, we can’t live without them. We need to think of these good microscopic inhabitants of our bodies, as a part of us that we need to keep healthy. We have a “symbiotic” relationship: we evolved together and rely on each other for survival.

The pharmacy school at the University of Toronto recently hosted an online Town Hall Medicine summit on the microbiome, where 21 researchers spoke about results of research they have been conducting in this area. I listened to most of the lectures and want to share some of what I learned. The series is still available (for a fee) if you are interested in learning more.

What do microbes do for us?

These microorganisms perform many bodily functions for us: from helping to digest our food and absorb nutrients, to protecting us from disease, to controlling how our immune system functions, and more. Although they’ve been researching our microbiome for over 10 years, scientists are still learning new ways they interact with our human cells with significant increases in understanding in the last 5 years. They now believe there is a connection between the make-up and health of the microbiome and obesity, autism, allergies, intestinal health, responses to drugs, rheumatoid arthritis, Type 1 diabetes and many other conditions.

Inflammatory diseases, like Multiple Sclerosis (MS), asthma and Crohn’s disease, have been on the rise over the past 50 years. Researchers have proposed the “hygiene theory” which suggests that decreased exposure to microbes, through overuse of antibacterial agents and just being too clean, has lead to decreased diversity of our bodies’ beneficial microbes. Some evidence suggests that exposure to good bacteria in the early years of life is crucial to avoid inflammatory diseases, such as asthma and inflammatory bowel disease, later in life. Think of it as giving your immune system “exercise” to help it strengthen and learn to function properly.

The gut and the brain “talk” to each other…

Recently they have even identified communication between gut bacteria and the brain, through hormones, nerves, and chemicals known as neurotransmitters. They believe that this communication affects our mental health. What we eat influences the composition and activity of the microbiome and this has lead to research on how our diet could influence mental health. For example, newer studies suggest eating a western diet of highly processed food may increase risk of depression and anxiety. But choosing a Mediterranean diet, with higher amounts of vegetables and good fats like olive oil, may reduce risk of these mood disorders. This field of study is called nutritional psychiatry.

We also have a major nerve, called the vagus, that directly connects the brain and the gut. Years ago, surgeons would sometimes cut this nerve in patients who had ulcers caused by stress. The ulcers healed, but many patients developed psychiatric problems afterward. It turns out that this nerve is a two-way street, carrying messages from the gut to the brain as well as in the other direction, and it’s another important way our gut and our brain communicate.

I’ve read about an abdominal breathing technique that is suggested help with relaxation: the belly is pushed out during inhalation and pulled in while exhaling. I’d always thought this was just a distraction technique, a type of meditation to take a person’s mind off their troubles. But I’ve learned that this abdominal movement can stimulate the vagal nerve when done correctly, actually creating a relaxation response in the brain. However, experts stress that it requires practice to be able create a full parasympathetic relaxation response that is useful during an episode of stress. Seems like a worthwhile skill to develop!

Exposure early in life is important

Studies of asthma and allergies are very telling. Children who receive an antibiotic in the first year of life have higher rates of asthma. Studies also suggest growing up on a farm, with a dog, or being born by natural birth versus by sterile caesarean section can result in lower risk for asthma and allergies. All of these affect the types of bacteria a child is exposed to early in life and therefore will incorporate into their digestive and other systems. It seems that exposure to organisms in the first 3 years of life – while the immune system is developing – is more important with longer-lasting effects than later in life when our systems are well-established. Trying to repair and maintain a microbiome that is damaged as an adult is more difficult than establishing a healthy one in the first place and requires ongoing effort. Researchers describe extinction of entire species of microbes in the inside world, the gut, of some populations. And they can be very difficult to reintroduce, just as it’s almost impossible to reintroduce animal species that have become extinct in the outer world. Keep in mind that a typical probiotic capsule contains less than 10 species of organisms, compared to around 10,000 species in a healthy adult. Although probiotics can help some, we need to do more.

How can we help out our gut microbes?

Factors that affect the composition of our microbiome include the types of food we eat and where we spend our time. With modern urban living, many can spend as much as 90% of their time indoors. Simply spending time in nature can change the types of organisms we take into our bodies. Bringing fresh fruits, vegetables and plants into the home can help recreate “the farm effect” with benefits to our microbiome.

Eating fermented foods can also help, as the fermentation process creates many beneficial bacteria. One expert recommends five servings per week of at least three different types of fermented foods. These foods also provide fibre, which feeds good bacteria. Although raw foods contain more live bacteria than those that have been cooked, even organisms killed in the cooking process benefit the immune system.

Just like a garden…

One expert, Anne Bikle, who is also an avid gardener, describes our large bowel as a “garden” and a “medicine chest”, producing substances that protect us from abnormal, potentially cancerous, cells as well as infections. She tells us that 40% of the compounds in our blood are made by our microbiome, and that we are as much microbial as we are human. She suggests we need to treat our digestive system as we would a garden: feed it plenty of fiber and nutrient rich plants, just as you would add nutrients and compost to soil to have a healthy garden that produces tasty vegetables or beautiful flowers. Her advice in a nutshell? “Mulch your garden soil, inside and out”. Keep your inside world and your outside world healthy…

Reference:

Town Hall Medicine, University of Toronto, Leslie Dan Faculty of Pharmacy

Are we more microbe than human?

Categories
Book review Health

Bacteria for Breakfast, Probiotics for Good Health – A book review

Did you know that at least 90% of our bodies’ cells are not human? They are bacteria that live mostly in our digestive system (about 3 pounds worth!), as well as on our skin, in the lungs, and within the urinary and genital tracts.

These are “good” bacteria that help prevent disease by reducing growth of “bad” bacteria that can cause harm. These good bacteria also produce some nutrients that we need, help digest our food, provide energy in the form of short chain fatty acids, and stimulate our immune systems. And, just being there in sufficient numbers, they crowd out other bacteria that could cause us harm. The make-up of this bacterial flora varies from person to person, and may account for our variable risks for certain diseases.

Pharmacist, Dr. Kelly Dowhower Karpa, wrote Bacteria for Breakfast, Probiotics for Good Health after using probiotics (supplements of good bacteria) to cure her 2-year-old son’s infection of C. Difficile bacteria that was resistant to all antibiotics that his doctors tried. She did extensive research into how these good bacteria keep us healthy before beginning to write and, although some parts of her book are quite technical with explanations designed to answer questions doctors may have, the book is written for the general public. The goal of her book is to educate patients themselves, and to enable them to discuss their gut health with physicians. I will present a brief overview of some of the topics she discusses.

The book focuses on bacteria that live in our digestive systems, from the mouth where they prevent bad breath and dental cavities that can be caused by unfavourable bacteria, to the intestines where imbalances can promote inflammatory diseases. It explains how the stomach is designed to produce acid that kills bacteria that may be in our food but when acid is chronically suppressed with commonly used medications, such as Zantac, Losec (Prilosec), Nexium, etc., or is naturally reduced these bacteria are more likely to survive and the risk of gut infections is increased.

Food allergies can occur when overgrowth of bacteria damages the lining of the bowel, allowing undigested food particles to pass through into the blood stream, triggering allergic reactions to these large proteins that are not normally found in blood (termed “leaky gut syndrome”). This “leakiness” is also associated with inflammation, severe infection, organ failure and even death. Wide-spread activation of the immune system can lead to inflammation, severe allergies, asthma, eczema and even anaphylaxis (a life-threatening allergic response).

The incidence of these immune-related conditions has exploded in the past 50 years, suggesting non-genetic factors are involved. Two major changes are increased hygiene resulting in less exposure to various bacteria, and change in diet with more sterile pre-packaged food and less fresh, fermented and dried foods that would contain various bacteria. Our first exposure to bacteria usually occurs during birth, when passing through the birth canal, so babies born by Cesarian Section do not receive this initial dose of good bacteria and sometimes never develop an ideal gut flora. As well, if the mother has a less than ideal balance of bacteria, then this is what is passed on to the baby.

The effect of our bacterial flora can easily be seen in changes in the daily elimination function of the bowel. After treatment with a course of antibiotics, which kill healthy bacteria along with the infectious bacteria being treated, bowel function often changes with development of either diarrhea or constipation that can be corrected with supplements of good bacteria (probiotics). You may have noticed a difference in your digestion after eating fermented foods that still contain live bacteria. Chronic constipation that is resistant to various laxatives or returns as soon as the laxative is discontinued, will also sometimes respond to a course of probiotics. Keep in mind that probiotic supplements generally contain much more bacteria than you would get in foods like yoghurt, and might be preferred when trying to correct a serious imbalance in gut bacteria.

Dr. Karpa also explains an additional hypothesis for how bacteria may increase our risk for disease in detail with supporting evidence from studies. Although complex, I will try to explain this briefly…

The gastrointestinal tract is considered to be the largest immune system organ, and it communicates with the immune system throughout the body by producing immune particles called cytokines. Good bacteria activate the immune system, by stimulating production of cytokines that create a low-level inflammation. Some of these cytokines also enable production of the thick layer of mucous that protects the cells that line our digestive system. Still other cytokines are produced that limit the amount of inflammation that is created.

If we do not have the correct balance of cytokine-producing bacteria, we could be missing the protective mucous layer (allowing damage to occur in the intestinal wall with resulting leakage of undigested food proteins), we could be lacking enough stimulation of the immune system (leading to poor protection against common infections) or we could become less able to block excessive inflammation (leading to autoimmune diseases like allergies, asthma, inflammatory bowel disease, rheumatoid arthritis, etc.). The book cites many examples of improvement in chronic health conditions with adequate supplementation of probiotics (or good bacteria) and explains in detail how changes in gut flora are connected with various health conditions.

Disturbed gut flora has been described as potentially playing a critical role in the development of various autoimmune diseases (where the body’s immune system attacks an organ system) such as:

  • Inflammatory bowel disease

  • Type 1 diabetes

  • Rheumatoid arthritis

  • Hashimoto’s Disease (thyroiditis)

The book also briefly describes the benefit that some patients experience by also adding pancreatic enzymes or plant enzymes to help digest food, leading to a reduction in food allergies presumably by increasing the breakdown of proteins they contain. This might be another avenue to discuss with your physician if you have chronic severe food allergies.

As a pharmacist, I believe it is preferable to prevent disease or to treat the root cause, if possible, rather than to simply control the symptoms. I think this is why I found this subject fascinating and wanted to share a little of this information with you.

Other recent research I have stumbled across, suggests that gut bacteria may also be associated with changes in the frontal lobe of the brain that could be associated with autism or schizophrenia. Another report suggests a possible association between gut bacteria and the ability to create the protective myelin sheath (the covering that insulates nerve cells) that is destroyed in degenerative nerve diseases like Multiple Sclerosis. Probiotics have even been noted to increase the beneficial effect of vaccines. So you can easily see that many problems may originate with imbalances in the digestive system’s bacteria, and research continues to look for these associations and how they occur.

If you are interested in reading further, here is information on the book I have reviewed:

Bacteria for Breakfast; Probiotics for Good Health, Dr. Kelly Dowhower Karpa, Trafford Publishing, ISBN 1-4120-0925-0.