There is an increasing awareness of gut health and its impact on certain diseases. Latest research shows that a healthy gut increases our vitality, strengthens our immune system, supports our metabolism and contributes to how we feel on a day to day basis. So how do we keep our gut happy and healthy? Most people nowadays are aware of the power of probiotics in the overall health and function of their gut. Essentially, probiotics are live microbes that have been found to have health benefits when supplemented in the proper amounts (1). One function of probiotics is to keep our digestive system working at optimum standards. Research has shown that there are several ways in which probiotics do this. Probiotics have the ability to not only positively modify the microflora already found in your gut, but it can also positively modify your immune system. These live microbes produce metabolites with anti-inflammatory properties, which can help people suffering from gastrointestinal (GI) diseases like Inflammatory Bowel Disease (IBD) (2).
What is IBD?
IBD primarily refers to two types of inflammatory diseases depending on the origin – one in Colon known as Ulcerative Colitis or one at the end of the small intestine where it meets Colon known as Crohn’s Disease. According to the Crohn’s & Colitis Foundation of America (CCFA), approximately 2 million Americans suffer from IBD. These diseases come at a serious cost to the people suffering from them with symptoms like diarrhea, fatigue, abdominal pain, bloody stool, loss of appetite and unintended weight loss. IBD symptoms vary in intensity daily leaving patients wondering what the next day will hold. These diseases also have the ability to worsen with complications including colon cancer, blood clots, bowel obstruction, malnutrition, fistulas and anal fissure to name a few. Though the etiology of the disease is still widely unknown, researchers believe that there may be a link between the patient’s genetics, microbiome, nutrition and the inflammation in their GI tract. What the gut should be doing and what it is doing, don’t align. There is a miscommunication that tells the body to attack the GI mucosa lining causing inflammation, ulcers and a slew of other issues found in patients with CD and UC (3).
How do you treat it?
Traditional treatments for these diseases include anti-inflammatory drugs, corticosteroids, immunomodulators, and antibiotics. The overall betterment of the patient on these drugs is modest and continual research is being done to find alternative ways to cure them of their intolerable symptoms. In recent years, research has shown that the implementation of probiotics in models with IBD proves to be an effective and reliable alternative to traditional treatments often mimicking what they do, but better.
What role is microbiome playing?
A study done by Sokol et al. identifies a link between the diversity and abundance of bacteria belonging to the gram-positive Firmicutes phylum and patients suffering from CD. Their research showed that a reduced abundance of Faecalibacterium praunitzii was commonly seen in patients with CD. When tested in animal models induced with disease, the introduction of F. praunitzii counterbalanced the dysbiosis (impaired microbiome) and exhibited anti-inflammatory effects. The use of this probiotic corrected the dysbiosis caused by the disease by way of blocking NF-KB activation and IL-8 production with the metabolites secreted by the microbe itself (4). Other studies have supported this claim as well, finding that F. praunitzii can act as a therapeutic agent that downregulates pro-inflammatory cytokine, tumor necrosis factor α (TNF-α), and T-cells (5). TNF-α is a key player in the inflammatory process of IBD because of its regulatory functions within a cell. This cytokine’s biological functions regulate cell survival and proliferation making it an important marker for those suffering from IBD.
Along with F.praunitzii, other strains of bacteria perform immunomodulatory functions as well. Bifidobacterium infantis is able to benefit us by mimicking commensal-immune interactions. A study comparing the effect of B.infantis on human models suffering from UC and two other non-gastrointestinal diseases, chronic fatigue syndrome and psoriasis, found that this microbe has the ability to reduce pro-inflammatory biomarkers TNF-α and Interleukin-6 (6). The data concludes that probiotics are not limited to helping only those with gastrointestinal diseases but can be extended into the immune system as a whole.
Where do we go from there?
While the treatment so far for IBD has been focused on reducing inflammation and providing relief, none of the existing treatments provide a cure because they don’t change the primary cause. The possibility that there is an alternative treatment for a disease like IBD by changing dysbiosis which may be the primary driver is quite revolutionary. The fact that there are virtually no repercussions and no side effects begs the obvious question of is this too good to be true? Unfortunately, most GI doctors were never trained in microbiomes, and it would take many years before they are convinced of changing their practices. Or maybe treating with expensive biological drugs is so financially lucrative; there is no incentive for the doctors to change unless an overwhelming amount of data convinces every opinion leader to rethink this. In any case, I think this is an exciting area where the alterations of a second genome (microbiome) can be a true game changer.
- Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 2014; 11(8): 506-514.
- Larissa Sbaglia Celiberto, Raquel Bedani, Elizeu Antonio Rossi & Daniela Cardoso Umbelino Cavallini (2015) Probiotics: The scientific evidence in the context of inflammatory bowel disease, Critical Reviews in Food Science and Nutrition, 57:9, 1759- 1768, DOI: 10.1080/10408398.2014.941457
- Panaccione, R. (2013). Mechanisms of Inflammatory Bowel Disease. Gastroenterology & Hepatology, 9(8), 529–532.
- Sokol, H, Pigneur, B, Watterlot, L, et al. (2008) Faecalibacterium prausnitzii is an anti- inflammatory commensal bacterium identified by gut microbiota analysis of Crohn disease patients. Proc Natl Acad Sci U S A 105, 16731–16736.
- Rebeca Martín, Florian Chain, Sylvie Miquel, Jun Lu, Jean-Jacques Gratadoux, Harry Sokol, Elena F. Verdu, Premysl Bercik, Luis G. Bermúdez-Humarán, Philippe Langella; The Commensal Bacterium Faecalibacterium prausnitzii Is Protective in DNBS-induced Chronic Moderate and Severe Colitis Models, Inflammatory Bowel Diseases, Volume 20, Issue 3, 1 March 2014, Pages 417–430,
- David Groeger, Liam O’Mahony, Eileen F. Murphy, John F. Bourke, Timothy G. Dinan, Barry Kiely, Fergus Shanahan & Eamonn M.M. Quigley (2013) Bifidobacterium infantis 35624 modulates host inflammatory processes beyond the gut, Gut Microbes, 4:4, 325-339, DOI: 10.4161/gmic.25487