Introducing a major player in microbiota research

Introducing Rob Knight...
Rob Knight is a Scientist from the US and a co-founder of the American Gut Project.
His short biog says he 'explores the unseen microbial world that exists literally right under our noses — and everywhere else on (and in) our bodies.'

Here is his TED talk about how our microbes make us who we are... It is a very interesting video, my favourite bit is the following:

'But imagine if there were a kind of neglected organ in our bodies that weighed just as much as the brain and in some ways was just as important to who we are, but we knew so little about and treated with such disregard. And imagine if, through new scientific advances, we were just beginning to understand its importance to how we think of ourselves. Wouldn't you want to know more about it?'

What are you most afraid our microbiota will tell us? Would you like to have yours analysed?

I'd love to read your thoughts, feel free to leave me a comment.

Donate your poo to help people live a healthier life

A new technique called fecal microbiota transplant (FMT) used to help people with recurrent intestinal infections who do not respond to standard treatment relies on one very important thing: people's poo donations.

C.difficile infections are devastating for people who suffer from it as their quality of life is tremendously impaired due to frequent and painful diarrhoea episodes.
This infectious infection is due to the overgrowth of a gut bacterium called clostridium difficile and usually occurs after taking broad-spectrum antibiotics or any antibiotic for a long period of time. People may have underlying conditions that make them more susceptible of overgrowing or contracting that infection, which is detected by poo analysis.

Ironically, standard treatment for c.diff is a course of another antibiotic. Although people usually respond well, one in five persons will have recurring symptoms. For them, a vicious cycle of diarrhoea and antibiotics starts with sometimes no hope in sight.

That was until friends and relatives of a sufferer decided to create OpenBiome in 2012 (US based) after seeing him recovering completely following a fecal transplantation.

The principle of this technique is fairly simple: healthy donors have healthy balanced microbiota in their gut and poo and by 'inserting' that poo in a sick person's gut, the healthy bugs in the poo take over and rebalance the sick person's gut flora.

It may sound gross but this is a life-saving technique for people with this infection. It could also become more mainstream as this technique has also been suggested for a whole range of diseases including obesity (a trial has recently started to assess efficacy of poo pills on our weight - article coming soon).

But don't think it's easy to donate and get money from your poo. To be accepted as a poo donor, you have to be pretty clean-living in order to have the perfect balance of bugs' species in your poo.

For more information, visit OpenBiome.

Would you donate your poo if you knew it could help so many people? Would you agree to swallow a poo pill if it cured you of painful and recurrent diarrhoea?

Feel free to share your stories in the comments section, I'd love to read them.

See you next Monday!

Irreversible impact of a low fibre diet on gut flora

Any diet and health book, blog, advice will tell us to increase our intake of fibres. Fibres are essential for a variety of reasons including helping digestion, regulating our metabolism (avoid obesity and diabetes), avoid cardiovascular issues (lowering cholesterol), etc.

But did you know there are two types of fibres? Solubles and insolubles?
Both types behave differently in the gut, but they all end up being munched by our lovely gut flora species.

Those insoluble fibres are essential food for our little bugs. Without them, they are not doing too well. As the diversity in species is key to a healthy you, starving some species off simply results in an unhappy and unhealthy gut. The consequences of which can range from allergies to cancer.

Unfortunately, a recent study on mice showed that by being on a low-fibre highly-processed Western diet, entire species of friendly gut bacteria are starved off and never fully recover - even once back on a healthy high fibre diet.*

What was more worrying though was that this newly balanced gut flora with unhealthy species of bugs was passed on to new generations of mice (mainly from mum to baby as he gets born), and this with even less chance of recovery through healthy eating: some species were in fact completely extinct by generation number four!

This finding, combined with knowing that our Western lifestyle habits such as C-sections, formula feeding, and the overuse of antibiotics results in a poor gut flora diversity, should help us make a definite move towards a healthy life if we don't wish to affect future generations.

Where can I find good fibres, I hear you say: wholemeal bread, nuts, seeds, skin of fruit (apple, grapes, tomato), prunes, dates, popcorn, brown rice, bell peppers, cabbage, onions, lettuce, beans, peas, potato skin, cucumber skin, courgette, cauliflower, celery, avocado, unripe banana.

How do you take your fibres? Do you eat your recommended 30g/day?

Feel free to share your stories in the comments section, I'd love to read them.

See you next Monday1

The study can be found here

The influence of gut flora on anti-cancer treatment

These two concepts may feel completely foreign to one another, but there is in fact a solid background to suggest one's anti-cancer treatment may be as effective as one's gut flora is diverse.

We know that cancer cells have developed a system to bypass the immune system so that our body is not efficient at fighting them.

On the other hand, we've always known that the gut flora and all our microbes all over our body have developed a partnership with our immune cells. From birth, the first microbes residing in and on us help us fight our invaders (more on this here).

The past five years have seen a surge in publications linking the two showing that gut flora diversity is key to fighting cancer on three fronts:

1. Diversity helps to avoid pro-cancer species to multiply in excess, which would help the rise of cancer cells

Indeed, colorectal cancer has now been firmly linked to an imbalance between good and bad bacteria in the gut flora with a predominance of fusobacterium, a pro-inflammatory species that drives cancer DNA mutations - more on this here.

2. Good species help the immune system fight the cancer cells
3. Good species help the body cope with chemotherapy and radiation side effects that affect the immune system

Microbial species in your gut are able to modulate the activity of different components of our immune system that aid the anti-cancer drug to fight cancer.*

So what can we do with this information? Currently there are only a few dietary measures that we can apply to hopefully avoid a microbial imbalance. I will address these very soon in a Monday article.

Did you know that some doctors advise you to take some probiotics when undergoing anti-cancer treatment?

Please feel free to share your stories or thoughts in the comments below, I'd love to read them.

See you next Monday!

* The two papers are: Iida N, et al. Commensal bacteria control cancer response to therapy by modulating the tumor microenvironment. Science 2013; 342: 967-970.
Viaud S, et al. The intestinal microbiota modulates the anticancer immune effects of cyclophosphamide. Science 2013; 342: 971-976.

The impact of antibiotics on a newborn's microbiota

When baby is born, his mum has prepared the best microbial starter pack for him to be colonized with on his way out (if you'd like to read more about this, follow here).

However, in some cases when infections can occur during or after birth (especially after C-sections and in pre-term births), baby may be administered vital antibiotics to combat opportunistic infections. It has been estimated that 1.4 million of babies die at birth because of invasive infections; therefore, we can all agree that there are no questions over whether antibiotics are essential or not, they just ARE!!

But what happens to the first microbial colonies of baby when under attack by antibiotics.

A study looking at the microbiota of pre-term babies who received antibiotics showed that these babies had in their gut an unusual amount of a family species called enterobacteriaceae.

It might not mean anything on its own, but because our microbes have established a balance between themselves, if you tip that balance, their carefully attributed functions are all messed up and it can take up to two years to re-establish a  correct balance between the species.

Today we are recognizing the effects of a tipped balance on our health. Unfortunately, consequences linked to the administration of antibiotics to babies are, for example, an increased risk of developing auto-immune diseases such as inflammatory bowel disease (Crohn's, colitis), Type I diabetes, and allergies.

Unfortunately, there is as yet no alternatives to antibiotics that are as effective in delicate situations such as to ensure baby's survival.

Recently, some scientists have found a way to combat bacterial infections using a different mechanism of action. Although it will take years before we can see the alternatives being applied to clinical practice, I'm hopeful that the incidence of some of these diseases will decrease thanks to, once again, progress in our understanding as to how nature works.

Do you know children with allergies that you think may be linked to having been given antibiotics at birth?

Don't hesitate to share your stories in the comments below, I'd love to read them.

See you next Monday!

The vaginal swab technique for C-section babies

Although it may sound really gross, this is a revolutionising yet simple technique that has been devised to help C-section babies get the best microbial starter pack from their mums (find out what this pack is here).

Indeed, while C-section is an essential tool for mothers and babies for who natural birth may put them at risk, those little bundles of joy are missing some vital ingredients they would have encountered on a natural way out: mum's vaginal microbes.

However, in many countries, it is possible to simply choose when to have your baby. It may seem the next logical step in our 'civilised' and sterile way of living but what about those friendly microbes? More and more scientists are realising that these first microbes baby encounters on his way out determine the level of risk of developing many diseases (coming soon).

When the wife of one of those experts in microbiota gave birth by emergency C-section, he didn't take any chance and applied the vaginal swab technique to his own baby. I recently read that one year on, their baby was very healthy and had not shown any of the signs C-section babies are most at risk such as allergies and eczema.

How to do a vaginal swab?

From Dominguez-Bello et al, 2016.*

The technique consists in keeping a sterile wipe inside the mum's vagina up until the last minute. When baby is out through mummy's tummy, the wipe is applied on baby's mouth, face, and then the rest of his body as if he had been pushed out through mum's vagina with maximum contact in the mouth, then face, then body.

A super recent study* examined how efficient this technique is. Their results showed that gut, oral, and skin bacterial communities of these swabbed newborns were enriched in vaginal bacteria during the first 30 days of life, similar to vaginal birth babies' and, most importantly, completely different from unswabbed C-section babies' - thereby demonstrating the effectiveness of the technique.

Would you ask for a vaginal swab if your baby needs to be born by C-section?

Let me know your thoughts in the comments section, I'd love to read them.

*The study I'm referring to is: Dominguez-Bello MG, et al. Nat Med 2016; doi:10.1038/nm.4039. 

What is the risk of GBS infection during water birth?

I would like to share with you Part II of the question I was asking myself: Is water birth bad for baby?
If you'd like to catch up on the first part, please follow here.

When researching for answers, I came accross an article saying that it was bad; however, many professionals disagreed.
Interestingly one of them brought forward this article focused on the risk of GBS infection during water birth:

GBS stands for Group B Streptococcus and can be worrying for pregnant women who are found to have some in their gut (mums are called GBS carriers). In fact, up to 41% of women are carriers and 1 in 2 children born from these mothers will themselves be colonized by GBS. Out of all these children, it was estimated that 1% could develop complications that sometimes can be life-threatening (1 in 10).

This US paper stated that there was a 300% lower rate of early onset GBS infection when babies were born in water (and without using antibiotic prophylaxis) compared with babies born on dry land (both hospitals) - when looking at uncomplicated pregnancy (what are GBS' pregnancy complications?).

In the UK, pregnant women are not routinely screened for GBS (NHS)

The article concluded that if there is a risk of early onset GBS, the risk may be lowered by encouraging the mother to give birth in a warm water pool without antibiotics (effect of antibiotics at birth coming soon).

Another 2007 study showed that GBS-carrier mums who gave birth in the water - as opposed to laboured in the water and got out before the big push - contaminated the water pool with their GBS much more, nevertheless there were fewer of their children colonized by GBS!

In conclusion, for now we can say that water birth has not been shown to influence baby's gut early microbiota and it may even have a protective effect for babies at risk of GBS infection.

Do you know if you are a GBS carrier?

If you'd like to share your thoughts or stories, please don't hesitate to leave me a comment, I'd love to read them.

See you next Monday!

Scientific articles on GBS here and here