Trust­ing your gut on gut health

The Tribune (SLO) - - Sports & Weather - BY EVE GLAZIER, M.D., and EL­IZ­A­BETH KO, M.D.

Dear Doc­tor: I read with in­ter­est your col­umn about how sugar likely af­fects the gut, and I now have ques­tions con­cern­ing an­tibi­otic treat­ment. Are all gut bac­te­ria elim­i­nated? Can they be re­stored? Do pro­bi­otic sup­ple­ments help the gut re­turn to nor­mal?

Dear Reader: Near-daily dis­cov­er­ies about the power and po­ten­tial of the gut mi­cro­biome are trans­form­ing our un­der­stand­ing of both health and dis­ease.

The 10 tril­lion to 100 tril­lion micro­organ­isms that each of us har­bors in our di­ges­tive tract con­sist of more than a thou­sand species with more than 3 mil­lion genes. Not only do they play sig­nif­i­cant roles in di­ges­tion, syn­the­size vi­ta­mins and other nu­tri­ents, and co­or­di­nate with the im­mune sys­tem, re­search shows that our gut flora has a hand in reg­u­lat­ing mood, weight, in­flam­ma­tion and cer­tain dis­ease pro­cesses.

So what hap­pens to the gut mi­cro­biome af­ter an­tibi­otic treat­ment? Two well-re­garded stud­ies into the ques­tion, one per­formed in mice and one in healthy men, had sim­i­lar an­swers.

An out­come com­mon to both stud­ies was that, fol­low­ing an­tibi­otic ther­apy, the num­bers and di­ver­sity of the mi­cro­bial com­mu­ni­ties were vastly re­duced. The other was that once an­tibi­otic ther­apy con­cluded, the gut mi­cro­biome be­gan to quickly re­pop­u­late. How­ever, in both the mouse and hu­man stud­ies, a com­par­i­son of pre- and post-ther­apy fe­cal sam­ples re­vealed that the land­scape of the new gut mi­cro­biomes had changed sig­nif­i­cantly.

The mouse study found that in ad­di­tion to nearly erad­i­cat­ing the na­tive mi­crobes, an­tibi­otic ther­apy re­duced the meta­bolic rate of those that man­aged to sur­vive. The an­tibi­otics also caused cer­tain changes to the en­vi­ron­ment of the gut it­self. These two fac­tors opened the door to re­pop­u­la­tion of the mouse guts by new species, some of them po­ten­tially harm­ful.

The hu­man study found that al­though the gut had re­pop­u­lated the ma­jor­ity of its orig­i­nal species six months af­ter an­tibi­otic ther­apy, nine com­mon ben­e­fi­cial bac­te­ria failed to re­turn. At the same time, sev­eral po­ten­tially harm­ful bac­te­ria made an ap­pear­ance.

The take­away is that while the gut mi­cro­biome in most healthy adults is re­silient in the face of an­tibi­otics, the breadth and di­ver­sity of our mi­cro­scopic part­ners do take a hit.

One new area of re­search is the use of fe­cal trans­plants to both re­store the orig­i­nal ecosys­tem of the gut and pro­tect against col­o­niza­tion by un­de­sir­able species. This was done in a re­cent study in pa­tients un­der­go­ing in­tense can­cer treat­ment. Us­ing fe­cal sam­ples that were frozen and stored prior to their pro­ce­dures, pa­tients re­cov­ered a sig­nif­i­cant por­tion of their pre-treat­ment gut flora.

Send your ques­tions to ask­the­do­c­[email protected] med­net.ucla.edu, or write: Ask the Doc­tors, c/o Me­dia Re­la­tions, UCLA Health, 924 West­wood Blvd., Suite 350, Los An­ge­les, CA, 90095. Ow­ing to the vol­ume of mail, per­sonal replies can­not be pro­vided.

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