Download Gut Instinct Exploring the Partnership Between You and Your Belly

Gut Instinct
Exploring the Partnership Between
You and Your Belly
Joanna Wilson, D.O.
Women’s Health
Board-Certified Internal Medicine
-Bonnie Bassler (TED talk)
“HUMANS ARE 99% BACTERIAL.”
Mutualism
• Humans have 10 X more bacterial cells than
human cells
• Between 300-1000 species live in our
intestines
– 99% are anaerobes
• Intestinal bacteria have allowed us to obtain
greater nutrients from our food, develop
sophisticated immune systems, and the
balance affects cognition and emotions
Baby’s First Gift
• Vaginal flora changes
during pregnancy to
bacteria which are
better able to
metabolize breast milk
• Bacteria introduced
during vaginal delivery
to germ-free babies
establishes the baby’s
intestinal ecosystem
Starting with a different set of tools
• Intestinal bacterial
ecosystem introduced
to babies born by Csection resembles skin
flora of birth
participants
Breast Milk is the original pre- and probiotic!
Breast milk contains over 600 different kinds of
bacteria and it provides oligosaccharides to feed
the bacteria in the baby’s intestine.
Yum!
Take a peek
A Closer Look at Your Colon Lining
Colon Bacteria: Functions in Nutrition
• Improve acquisitions of vitamins and nutrients
from food
– Germ-free rodents required 30% more calories to
maintain weight
– Malnutrition can occur after antibiotic use
• Affect cholesterol metabolism
• Generate vitamins B1, B7, K
Ground Cover
• The dominant microbiota
is established in infancy
and inhibits colonization
by pathogens by
– Occupying luminal cell
receptors
– Releasing bacteriostatic
and microbicidally acting
substances
Colon Bacteria: Function in Immunity
• Assist in establishment of self vs non-self
recognition
– Germ-free mice have higher numbers of natural-killer
cells, with resultant increase in asthma and IBD
• Mediate activity of the immune cells of the colon
lining and control the intestinal lining
permeability
• Communicate with spleen and liver to control
immune cell response
Abnormal Immune Response to
Gastrointestinal Bacteria May
Contribute to Diseases
• Autoimmune Diabetes I
• Crohn’s Disease
• Ulcerative Colitis
Sanitized Society
Societal Behaviors Impact Future
Disease
• The drastic increase of children born without
h. pylori gastric bacteria correlates very
strongly with the increase in incidence of
allergies and asthma in children
• Children born by C-section have a higher rate
of allergies and asthma
Central Nervous System Priming
• 40 genes for learning,
memory, mood, and
motor control are
permanently affected
by the early presence of
gut bacteria
• Timing is everything
– Bacteria must be
established early in life
for benefits to occur
Mood and Colon Bacteria
• Several studies showed
germ-free mice who were
inoculated with specific
bacteria generated and
delivered neurotransmitters
to the brain, affecting
anxiety, corticosteroid
production, and colitis
symptoms
• Human studies using yogurt
with probiotics showed
emotion and sensitivity
were statistically different
when probiotics were
consumed
Colon Bacteria Alter Pain Perception
• Pain perception was
reduced in rats with
Bifidobacterium infantis
inoculation
• Lactobacillus
acidophilus induced
opiod and cannabinoid
receptors in intestinal
epithelial cells
Bidirectional Communication Methods
• Vagus (10th cranial nerve)
• Bloodstream (cytokines,
hormones,
neuropeptides)
• Spinal cord
• Allow for near-instant
reaction to acute change
in gut environment
Neurotransmitters are Highly
Preserved in Nature
Greatest
concentration of
serotonin is the
intestines!
Bacteria
Neurotransmitter Produced
Lactobacillus, Bifidobacterium
GABA
Escherichia, Bacillus,
Saccharomyces
Norepinephrine
Streptococcus, Escherichia,
Enterococcus
Serotonin
Bacillus, Serratia
Dopamine
Lactobacillus
Acetylcholine
Stress and The Belly
• Stress increases
permeability of the gut
lining to bacteria and
bacterial antigens
– Activates immune
response
– Changes the composition
of the gut microbiome
– Alters brain
neurochemicals
– Ex: inflammation promotes
E. coli proliferation
Highly Processed Diets Modify Colon
Bacteria
• Sugar/sugar substitutes
• High-fructose corn
syrup
• Preservatives
• Processed grains
• Alcohol
• Appear to be either
non-nutritive or
harmful to gut flora
Supplements Change Colon Flora
• Isoflavones for
menopause symptoms
changed bacterial
diversity and composition
• L-carnitine for muscle
gain induces colon
bacteria which convert it
into a substance which
causes atherosclerosis
– The same manner as a
high red meat diet does
Age and Sex Differences in Colon
Bacteria
• Aging causes:
– Reduction in anaerobes and bifidobacteria
– Increase in Enterobacter and endotoxin-producing
gram negative bacteria
• Stool pH is higher in women (less acidic)
Effect of Occupation on Colon Bacteria
• Ranchers harbored more Prevotella species
– Abundant in cattle and sheep
Enterotypes- Microbiota Profiles
• 1. Bacteroides- induced by a diet high in
animal protein, amino acids, and saturated
fats
• 2. Prevotella- induced by a diet high in
carbs/sugars
• 3. Ruminococcus
An Individual’s Microbiota is Generally
Consistent Through Life
• Foundation colonies tend to be consistent
over a person’s life
• About 40% of bacterial types are transient and
affected by diet, lifestyle, meds
Leanness, Bacteria Type, and Calorie
Absorption
Lean
Bacteroidetes
Lower energy
absorption
Obese
Fermicutes
Higher energy
absorption
Effects of Diabetes and Obesity on
Colon Bacteria
• 26 Species of bacteria correlated significantly
with obesity, insulin resistance, and metabolic
syndrome
• Bacteria from obese people had relatively
higher production of short chain fatty acids
– Increased production of leptin
• Increases appetite
Thin to Fat
• Inoculation of
genetically thin mice
with enterobacter
cloacae caused weight
gain
Fat to Thin
• Gastric Bypass Surgery
Alters Gut Flora
– Fecal samples from
bypassed colonized mice
to sterile non-surgerized
mice caused significant
weight loss in recipients
Future Treatments of Obesity
• Using bacterial flora to change nutrient
metabolism and inflammation
– Changing to a lower fat/ lower carb diet
– Human stool transplants from lean donors
Strain
Human Data
L. rhamnosus GG
Immune enhancement, infectious diarrhoea in children, primary prevention
of atopic dermatitis
B. lactis BB-12
Immune enhancement, diarrhoea in children
L. reuteri SD2112
Reduced absences from work, diarrhoea, immune function
B. infantis 35624
Irritable bowel syndrome (IBS)
L. casei DN114-001
Immune enhancement
B. longum BB536
Allergy symptoms, intestinal micro-ecology
L. acidophilus NCFM
Symptoms of lactose intolerance, reduced small-bowel bacterial
overgrowth
B. lactis HN019 (DR10)
Immune enhancement, especially in elderly
B. animalis DN173-010
Normalizes intestinal transit time
L. plantarum 299V
IBS, post-surgical gut nutrition
Lactobacillus casei Shirota YIT9029
Superficial bladder-cancer recurrence, intestinal microbiota, immune
enhancement
L. salivarius UCC118
Inflammatory bowel disease
L. johnsonii La1 (Lj1)
Immune function, Helicobacter pylori eradication
Escherichia coli Nissle 1917
Immune function, intestinal health
Saccharomyces cerevisiae (boulardii) lyo
Antibiotic-associated diarrhoea, Clostridium difficile infections
S. thermophilus (most strains)
Symptoms of lactose intolerance
Probiotic
• Probiotics are live microorganisms which, when
administered in adequate amount, confer a health
benefit on the host
– Not all strains confer the same benefits
– Colony Forming Units (CFU) dose varies for effectiveness
– Bacteria must be able to survive ingestion
– The effect of a probiotic is likely site-specific in the colon
– Sauerkraut, kimchi, pickles, yogurt, kefir, miso
(nonpasturized)
– May not have long-term impact without significant diet
change
Prebiotic
• Selectively fermented ingredient that results in specific
changes in the composition and/or activity of the
gastrointestinal microbiota, thus conferring benefit(s)
upon host health
– Resistance to degradation by the host
– Fermentation by intestinal microbes
– Stimulate growth or activity of intestinal microorganisms
– Breast milk, leek, asparagus, Jerusalem artichoke,
artichoke, garlic, onion, wheat, oat, soybean, bran,
psyllium
– Fructooligosaccharides (FOS), galactooligosaccharides
(GOS)
New Products May Encourage Residence of
“Good Bacteria”
Fecal Transplants
• Highly effective in
resistant C. difficile
colitis
• Safe and inexpensive
Future Uses Of Colon Bacteria To
Improve Health
• Create intestinal bacteria
which promote endocrine
functions, like insulin
production
• Produce highly selective, nonabsorbable antibiotics
• Invent drugs to alter bacteriato-bacteria communication
• Understand probiotics to
manipulate health and disease
• Transplant stool from thin
people for treatment of
obesity
• Improve nutrient absorption
to end starvation