FORGOT YOUR DETAILS?

Reading Time: 11 minutes

By Michael E. Ash BSc DO ND and Garth L. Nicolson, PhD

On the front line of primary care the two most common complaints are fatigue and gastrointestinal problems. Fatigue is the most common; up to 45% of consultations mention fatigue as the major complaint.[1],[2] If unresolved, it can progress to the point that it causes disability comparable to that found in chronic medical patients.[3],[4]

Reading Time: 19 minutes

The saying is ‘what happens in Vegas stays in Vegas’, or if you are English ‘what happens in Blackpool….’ but the same cannot be said about what happens in utero, as increasing evidence supports the understanding that the maternal nutritional environment and early feeding affects the health of the foetus beyond infancy and into adulthood.[1],[2] An article in Nature’s Mucosal Immunology this month explores some of the key events in foetal and neonatal immune management.[3] It stimulated a revisit to the area of what to consider for parents to be and mums of young children when they ask ‘is there anything I can do to prevent or reduce the risk of allergy or atopy in my child’.

The first moments, weeks and months of life can determine the health outcomes of an individual over the duration of their lifetime and this knowledge represents a significant choice for prospective parents. Fortunately the remarkable adaptability of the immune and central nervous system means that there are numerous opportunities in the early years of life to positively influence health outcomes even if the early stages were less than optimal.

Reading Time: 2 minutes

One in 10 schoolchildren in the western world suffers from eczema and even developing nations have also seen an increasing trend in the last few decades. There are many proposals to explain the increased incidence, one area of relevance is the environmental impact. Falling under the often misused ‘hygeine hypothesis’ title it has been proposed that there is a reflective difference in the gradient between rural and urban children. Implying the environmental impact on the developing immune system of children is different and therefore less protective in the urban setting.

This concept has now been studied in a recent article in the British Journal of Dermatology.[1] By conducting a Medline and Embase data base review studies that compared the incidence between the two environments were reviewed. Some 26 papers were assessed with 19 demonstrating a higher risk for eczema in an urbanised area, of these 11 were regarded as being statistically significant. A further 6 studies showed a lower risk of eczema in an urbanised area, of which just 1 was statistically significant.

Reading Time: 6 minutes

A trial to see if the ingestion of a probiotic bacterium enriched drink might have a beneficial impact on central obesity was funded by Snow Brand Milk Products company in Japan and the results were published in the European Journal of Clinical Nutrition this June 2010. [i]

Whilst it may seem a stretch that bacteria can influence our body mass, (I have written a previous review) it is an area of growing interest and investigation as bacteria have previously been implicated in the metabolic storage of fat. Studies in mice have shown up to 30% greater fat storage in mice with gastrointestinal colonies of commensals rather than their skinnier counterparts operating with sterile guts.

One proposal for this is that certain bacteria (Bacteroides Thetaiotaomicron is one likely contender) are able to manipulate energy to be stored in adipocytes through a pathway that involves microbial regulation of the intestinal epithelial expression of fasting-induced adipocyte protein (Fiaf), a circulating inhibitor of lipoprotein lipase (LPL).[ii]

The microbiota can then, based on this and other studies be viewed as a metabolic “organ” exquisitely tuned to our physiology and performing functions that we have not had to evolve on our own.

A Bacteria Triggers Arthritis.

Thursday, 01 July 2010 by | Comments: 2
Reading Time: 4 minutes

The gut microbiomes of humans and mice are broadly similar which is helpful as this paper has used the mouse model to explain how a resident bacteria in the gut can induce arthritis. In both hosts human and mouse upwards of ∼1000 different microbial species from ∼10 different divisions colonise the gastrointestinal tract, but just two bacterial divisions—the Bacteroidetes and Firmicutes—and one member of the Archaea appear to dominate, together accounting for ∼98% of the 16S rRNA sequences obtained from this site.[1] 16SrRNA is a laboratory method for analysing bacterial and provides species-specific signature sequences useful for bacterial identification but is not routinely used in diagnostic settings yet.

Their analysis revealed that despite the enormous species variation in the gut a single species of bacteria that lives here is able to trigger a cascade of immune responses that can ultimately result in the development of arthritis.[2] Gut-residing bacteria can also play a role in disorders of the immune system, especially autoimmune disorders in which the body attacks its own cells. The gut microbiota is now known to shape intestinal immune responses during health and disease with systemic effects.

Reading Time: 8 minutes

Michael Ash BSc(Hons) DO, ND, DipION reviews the possibility that strategically selected foods and food concentrates represent a valid therapy for inflammatory illnesses.

There is substantive interest in the potential translation from bench to bedside of simple safe strategies to modify the adverse effects of inflammation. Approaching from a preventative and restorative angle the numbers of papers being published on the role of orally ingested bacteria (probiotics) and in this article – the herb Tumeric (active ingredient of which is curcumin) is presenting increasingly supportive evidence for their reasonable and safe clinical use.

Modern analytical techniques are helping to reveal novel opportunities for inflammation control in the gut and the systemic tissues in new ways that even a few years ago would have been thought of as very alternative!

Antibiotics Can Cause Gut Related Diseases

Thursday, 18 March 2010 by | Comments: 4
Reading Time: 7 minutes

Michael Ash BSc (Hons), DO, ND FDipION reviews the current understanding of the role of antibiotics in the initiation of gut associated inflammation and local and systemic health problems, and briefly explores some strategies to prevent and manage this.

What is perhaps the greatest medicinal discovery in the last 100 years has a sting in its tail, the tremendous success in managing bacterial infection has encouraged over and inappropriate use of antibiotics, the problems of which have been well documented. This review explores the developing comprehension that even a single day of antibiotic use has consequences that may produce transient and long term effects that compromise the health and well being of the patient and their bacterial co-habitants.

Sir Alexander Fleming discovered the antibiotic substance penicillin in 1928 and was awarded a co share in the Nobel Prize in Medicine in 1945.

It was a discovery that would change the course of history. The active ingredient in that mould, which Fleming named penicillin, turned out to be an infection-fighting agent of enormous potency. When it was finally recognised for what it was—the most efficacious life-saving drug in the world—penicillin would alter forever the treatment of bacterial infections. By the middle of the century, Fleming’s discovery had spawned a huge pharmaceutical industry, churning out synthetic penicillin’s that would conquer some of mankind’s most ancient scourges, including syphilis, gangrene and tuberculosis. (Time Magazine April 1999)

However, as the combined benefits of decent engineering for sanitation, prevention via vaccination and bacterial infection control through antibiotics have contributed to life extension, they have also produced microbe and human disturbances. The incidence of immune mediated disorders is continuing to increase and the gastrointestinal tract is continuing to gain traction as a site of significant origination.[1],[2]

Gluten May be Causing Your Brain Problems!

Tuesday, 09 March 2010 by | Comments: 1
Reading Time: 3 minutes

An interesting paper published in the Sept 2008 Annals of Neurology described a ‘new to science’ brain aggravating enzyme, triggered by reactivity to gluten, but acting independently of other coeliac symptoms.[1]

Most clinicians understand that overt gluten reactivity is classified under coeliac disease and the the classic constellation of symptoms and signs characterising  malabsorptive syndrome is a readily recognised manifestation  of  coeliac  disease. Frank malabsorptive symptoms include steatorrhea, weight loss or failure to thrive, bloating, and flatulence, with multiple deficiency states. More common but more difficult to recognise, however, are the other diverse ways in which coeliac disease presents.

Coeliac disease may also mimic many common clinical entities. These atypical modes of presentation include deficiencies of single micronutrients; nonspecific gastrointestinal complaints such as bloating, abdominal pain, diarrhoea, constipation, flatulence, secondary lactose intolerance, and dyspepsia; and non-gastrointestinal complaints such as fatigue, depression, arthralgia, milk intolerance, osteomalacia or osteoporosis, and iron deficiency anaemia.

Reading Time: 2 minutes

Probiotics are widely consumed and the widespread advertising is often not really justified by the evidence. Many products were never studied as such and some companies use studies performed with other (and different) products for advertising.

In the March edition of GUT a systematic review on the randomised control trials (RCT) undertaken so far suggests that many are of good quality.[1], they determine that meta-analysis is impossible due to the various strains, phenotypes and genome vary greatly.[2] As a consequence and as stressed by the FAO/WHO joint report the benefits of one probiotic ‘cannot be extrapolated to other probiotic strains without experimentation.[3] However there tend to be properties consistent with different groups, from which strain specific organisms may be extracted.

Gut Bacteria May Make You Fat

Friday, 05 March 2010 by | Comments: 2
Reading Time: 18 minutes

Obesity: A consequence of adverse inflammation & microbial disruption?

By Michael Ash BSc(Hons) DO, ND, FDipION

Published in CAM 2005

Overweight and obesity are serious, chronic medical condition associated with a wide range of debilitating and life threatening and economically burdensome conditions. The recent and extensive increases in obesity among Europeans are eroding many recent health gains.

Paradoxically the economically wealthier communities of the world continue to over consume food and food products, whilst other nation communities still suffer from food deprivation and starvation, due in the main to drought, floods, ‘acts of God’, corruption and conflict. Approximately 9.5% of the global burden of disease is currently attributable to being underweight,[1] whilst there are now hundreds of millions of people (>500) in developed and developing countries that are overweight or obese. This condition of excessive weight is now so common that it is rapidly replacing malnutrition and infectious diseases as the most significant cause of ill health[2]. An escalating global epidemic of overweight and obesity – “globesity” – is taking over many parts of the world.

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