Gut Instinct Exploring the Partnership Between You and Your Belly

1. Gut InstinctExploring the Partnership Between You and Your Belly Joanna Wilson, D.O. Women’s Health Board-Certified Internal Medicine

2. -Bonnie Bassler (TED talk) “Humans are 99% bacterial.”

3. 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

4. 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

5. Starting with a different set of tools • Intestinal bacterial ecosystem introduced to babies born by C-section resembles skin flora of birth participants

6. 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!

7. Take a peek

8. A Closer Look at Your Colon Lining

9. 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

10. 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

11. 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

12. Abnormal Immune Response to Gastrointestinal Bacteria May Contribute to Diseases • Autoimmune Diabetes I • Crohn’s Disease • Ulcerative Colitis

13. Sanitized Society

14. 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

15. 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

16. 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

17. 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

18. Bidirectional Communication Methods • Vagus (10th cranial nerve) • Bloodstream (cytokines, hormones, neuropeptides) • Spinal cord • Allow for near-instant reaction to acute change in gut environment

19. Neurotransmitters are Highly Preserved in Nature Greatest concentration of serotonin is the intestines!

21. 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

22. 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

23. 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

24. 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)

25. Effect of Occupation on Colon Bacteria • Ranchers harbored more Prevotella species • Abundant in cattle and sheep

26. 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

27. 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

28. Leanness, Bacteria Type, and Calorie Absorption

29. 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

30. Thin to Fat • Inoculation of genetically thin mice with enterobacter cloacae caused weight gain

31. 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

32. 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

34. 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

35. 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)

36. New Products May Encourage Residence of “Good Bacteria”

37. Fecal Transplants • Highly effective in resistant C. difficile colitis • Safe and inexpensive

38. Future Uses Of Colon Bacteria To Improve Health • Create intestinal bacteria which promote endocrine functions, like insulin production • Produce highly selective, non-absorbable antibiotics • Invent drugs to alter bacteria-to-bacteria communication • Understand probiotics to manipulate health and disease • Transplant stool from thin people for treatment of obesity • Improve nutrient absorption to end starvation