Over the last few years, the science has emerged to prove that there is actually a close relationship between the respiratory, immune and gastrointestinal systems. We now know that a disruption to your biome (those trillions of microorganisms that live in your intestinal tract) can trigger an oversensitivity to allergens in your immune system, which could ultimately make your allergies flare up even more as a result. So, how do we support our gut? One acceptable method is to eat lots of healthy foods that are rich in fibre, as well as fermented products, such as kombucha. Of course, in
Dr Traj Nibber and Dr Anjan Nibber
Our gut contains billions of live bacteria, belonging to over a 1000 different species. In fact, the bacteria in our gut are thought to outnumber the number of cells of an adult person by 10-100 fold! These bacteria, or microbiota, play a crucial role in maintaining the delicate balance in the gut or homeostasis, including the metabolism of nutrients and the production of essential vitamins (K and B12). Gut microbiota can also prevent invasion of pathogenic bacteria by outcompeting them for adherence to mucosa and epithelium (the lining of the gut wall) for prime real estate. The composition of microbiota is ever changing and varies along the gastrointestinal tract (as the pH environment changes), and throughout life, as we eat different foods as children than as adults. Aberrant changes to the normal microbiota or dysbiosis have been implicated in a number of inflammatory conditions such as inflammatory bowel disease (IBD). IBD comprised Chron’s disease and ulcerative colitis, which are lifelong conditions that affect one in 150 Canadians, and the incidence is on the rise. Dysbiosis resulting in reduced bacteria diversity, dysregulation of immune cell differentiation, altered regulation of intestinal epithelial cell death mechanisms, and oxidative stress are just some of the pathogenic mechanisms hypothesized to lead to IBD. Over the last 20 years, the role of administering bacteria as a therapy for the IBD has been extensively studied. Below we will summarize a number of therapeutic strategies including prebiotic, probiotics, synbiotics and postbiotics.
Prebiotics comprise nondigestible carbohydrates such as fructo-oligosaccharide, inulin and lactulose that have been fermented by gut bacteria. These carbohydrates selectively promote the development of commensal (friendly) bacteria in the gut. Furthermore, studies have shown that prebiotics can increase the production of short-chain fatty acids (SCFA) such as acetate, butyrate and propionate. The combination of increased gut microbiota and a production of SCFAs results in a decrease in colonic pH (the colon becomes more acidic), which can inhibit the ability of pathogenic bacteria to survive and bind to the intestinal wall. SCFAs act as fuel for the enterocytes the main cells comprising the gut lining, which therefore preserves the integrity of the gut lining and reducing “leaky gut”. One unique strain is Clostridicum butyricum a strain only found in Japanese formulation called Bio-3. Currently, most of the evidence for the effectiveness of prebiotics has been conducted in animal models. Studies have shown that the administration of prebiotics selectively increases the growth of Lactobacillus (normal commensal gut bacteria), and decrease colonic lesions in rats with colitis.
Of the strategies discussed in this blog, probiotics have been the best studies. Probiotics comprise a single or a combination formulation of live bacteria, which are normal commensals of the gut – such as Lactobacillus and Bifidobacteria. The main benefits of probiotics can be conferred through the probiotics ability to outcompete pathogenic bacteria in the gut, and also by increasing gut barrier function. With regards to Chron’s disease, a number of studies have shown that Lactobacillus is beneficial in children. While, there is no data to suggest that probiotics can be used in the remission of Chron’s disease, there is a growing body of evidence to show that they have a significant impact in the post-surgical period. Probiotics have be shown to have a significant influence on the induction and maintenance of remission in patients with ulcerative colitis.
Probiotics have also been extensively studied in relation to skin health.
Synbiotics refer to a combination of prebiotics and probiotics. Studies have shown that this combination improves the survival of beneficial bacteria in the gut. Again the most commonly used probiotics include live Lactobacillus and Bifdobacteria, and the prebiotics fructo-oligosaccharide and insulin. A systematic review showed that synbiotics may effectively manage symptoms during the active stage of Chron’s disease. Furthermore, synbiotics have been shown to be useful during the remission stage of ulcerative colitis. Bio-3 a combination of three unique strains hitherto not found in Western probiotics. Together, these three strains combine to act not only as probiotics but as well as pre-biotics and synbiotics where the combination works better than individual strain.
A number of studies that shown that the health benefits of commensal bacteria do not necessarily require the bacteria to be alive. Postbiotics are soluble cell-wall components or metabolic byproducts released by live bacteria following lysis (cell death). These include enzymes, peptides, peptidoglycan derived products, polysaccharides and cell surface proteins. There are a number of factors that make postbiotics an attractive therapeutic strategy for IBD. First, unlike probiotics, postbiotics are not live. This means that the possibility of transferring over antibiotic resistance genes to any pathogenic bacteria that is the in the gut is minimal. Second, the concern for bacterial validity which exists with probiotic production is not a factor for postbiotics which are stable and have a long shelf-life. Finally, postbiotics are active and stable over a wider range of pH, which is important as the pH through the gastrointestinal tract is highly variable. While more research is required to fully understand the potential usefulness of postbiotics in the management of IBD, preclinical studies show great promise.
There are a number of new and exciting potential therapeutic strategies for the management of IBD. We hope that this has been a good introduction to some of the terms you may see in the literature. All of these strategies may have additional clinical use in the management of a range of other conditions such as skin health promotion and vaginal health, which we will explore in future blogs. Stay tuned!
Aggeletopoulou I, Konstantakis C, Assimakopoulos F, Triantos C. The role of the gut microbiota in the treatment of inflammatory bowel diseases. Microbial Pathogenesis: 2019;137: 103774
Aguilar-Toala JE, Garcia-Varela R, Garcia HS, Mata-Haro v, Gonzalez-Cordova AF, Vallejo-Cordoba B, Hernandez-Mendoza A. Postbiotics: An evolving term within the functional foods field. Trends in Food Science and Technology. 2018;75:105-114
Saez-Lara MJ, Gomez-Llorente C, Plaza-Diaz J, Gil A, The role of probiotic lactic acid bacteria and bifidobacteria in the prevention and treatment of inflammatory bowel disease and other related diseases: a systematic review of randomized human clinical trials, BioMed Res. Int. 505878; 2015;22:https://doi. org/10.1155/2015/505878.