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Dr. Fathi Neana, MD
Chief of Orthopaedics
Dr. Fakhry & Dr. A. Al-Garzaie Hospital
February, 21 - 2019
D Y S B I O S I S
Diversity and Biodiversity
Biological diversity, or biodiversity,
is the scientific term for the variety
and variability of life on Earth.
Biodiversity is the key indicator of
the health of an ecosystem.
Every living thing, including man,
is involved in these complex
networks of interdependent
relationships, which are called
ecosystems.
Diversity and Biodiversity
Like all healthy ecosystems,
Richness of microbiota species characterizes
the GI microbiome in healthy individuals.
Conversely, a loss in species diversity is a
common finding in several disease states.
Microbiota Biodiversity helps us :
1- Combat aggressions from other
microorganisms,
2- Maintaining the wholeness of the
intestinal mucosa.
3- Plays an important role in the immune
system,
4- Performing a barrier effect.
5- A healthy and balanced
gut microbiota is key to ensuring proper
digestive functioning.
ٍ‫ض‬ْ‫ع‬َ‫ب‬ِ‫ب‬ ‫م‬ُ‫ه‬َ‫ض‬ْ‫ع‬َ‫ب‬ َ‫اس‬‫ه‬‫ن‬‫ال‬ ِ ‫ه‬‫اَّلل‬ ُ‫ع‬ْ‫َف‬‫د‬ َ‫وَل‬َ‫ل‬َ‫و‬ُ‫ض‬ْ‫ر‬َ ْ‫اْل‬ ِ‫ت‬َ‫د‬َ‫س‬َ‫ف‬‫ه‬‫ل‬َ ‫ه‬‫اَّلل‬ ‫ه‬‫ن‬ِ‫ك‬ََٰ‫ل‬َ‫و‬َ‫ن‬ ِ‫ن‬َ‫ل‬‫ا‬َ‫ع‬ْ‫ل‬‫ا‬ ‫ل‬َ ََ ٍ‫ع‬ْ‫ض‬َ‫ف‬ ‫و‬ُ(251)‫ا‬ ‫سورة‬‫لبقرة‬
And if Allah had not repelled some men by others the earth would have been
corrupted. But Allah is a Lord of Kindness to (His) creatures. Sura Al-
Baqara: Verse 25
ِ‫ض‬ْ‫ر‬َ ْ‫اْل‬َ‫و‬ ِ‫ت‬‫ا‬َ‫او‬َ‫ن‬‫ه‬‫س‬‫ال‬ ُ‫ق‬ْ َ‫خ‬ ِ‫ه‬ِ‫ت‬‫ا‬َ ‫آ‬ ْ‫ن‬ِ‫ون‬ۚ ْ‫م‬ُ‫ك‬ِ‫ن‬‫ا‬َ‫و‬ْ‫ل‬َ‫أ‬َ‫و‬ ْ‫م‬ُ‫ك‬ِ‫ت‬َ‫ن‬ِ‫س‬ْ‫ل‬َ‫أ‬ ُ‫ف‬ َ‫َل‬ِ‫ت‬ْ‫اخ‬َ‫و‬َِِ‫ن‬ ِ‫ن‬ِ‫ل‬‫ا‬َ‫ع‬ْ ِ‫ل‬‫ل‬ ٍ‫ت‬‫ا‬َ ََ ََِ‫ل‬ََٰ ِ‫ف‬ ‫ه‬‫ن‬(22.)‫الروم‬ ‫سورة‬
And among His Signs is the creation of the heavens and the earth, and the
variations in your languages and your colours: verily in that are Signs for
those who know. Ar-Room: Verse 22
Diversity is a rule that govern
our life on earth
How epigenetics, our gut microbiome
and the environment interact to change our lives
Ben Locwin | Genetic Literacy Project | October 17, 2016
Research presented at the American Association for the Advancement of
Science 2014 conference
1- Supported that epigenetics and some form of heritability are in fact
linked.
2- Much of our lives and life trajectories could, in fact, reflect a sensitive
interplay between our environment, genes (epigenetics) and microbiome
3- The intersection of all of these factors is, quite simply, ‘us.’ as in the Venn
diagram
1- Children raised in more rural areas (more exposure to animals, dirt, debris, molds, pollen, etc.) suffer from
fewer cases of allergies than those children raised in more urban settings. Again, that pattern suggests an
interplay of our external environment, microbiome, and epigenetics.
2- Some novel research indicates that certain compounds produced by certain gut flora can make colon
cancer more prevalent by blocking the activity of DNA repair proteins.
3- The composition of the gut microflora can be changed very ‘rapidly and reproducibly’ in response to dietary
changes. Some of the consequences are directly due to microbial gene expression.
4- The inflammatory cascade of Crohn’s disease seems to be related to the gut microbiome and specific
microbes in particular.
Environment
Epigenome Microbiome
Life
Consciousness-Spirit
An epigenome consists of a record of the
chemical changes to the DNA and histone
proteins of an organism
These changes can be passed down to an
organism's offspring via transgenerational
epigenetic inheritance. Wikipedia
1- The epigenome is highly sensitive to external
environmental factors in early life, such as
nutrition, stress, endocrine disruption and pollution
Epigenetics, Gut microbiome and the Environment
a sensitive interplay
2- The epigenome is highly sensitive to internal environmental (Microbiota)
3- The changes in the epigenome can induce long-term changes in gene expression and phenotype.
4- The external environmental factors (our environment) affects our microbiome (The internal
environmental)
Epigenetics and lifestyle
Jorge Alejandro Alegría-Torres,1 Andrea Baccarelli,2 and Valentina Bollati3,*
Epigenomics. Author manuscript; available in PMC 2013 Aug 26.
Published in final edited form as: Epigenomics. 2011 Jun; 3(3): 267–277.
doi: 10.2217/epi.11.22 PMCID: PMC3752894 NIHMSID: NIHMS498542 PMID: 22122337
The concept of “lifestyle” includes different factors such as nutrition, behavior, stress,
physical activity, working habits, smoking and alcohol consumption.
Increasing evidence shows that environmental and lifestyle factors may influence
epigenetic mechanisms, such as DNA methylation, histone acetylation and microRNA
expression.
Several lifestyle factors have been identified that might modify epigenetic patterns,
such as diet, obesity, physical activity, tobacco smoking, alcohol consumption,
environmental pollutants, psychological stress, and working on night shifts.
Most studies conducted so far have been centered on DNA methylation, whereas only a
few investigations have studied lifestyle factors in relation to histone modifications and
miRNAs.
Here, we review current evidence indicating that lifestyle factors might affect human
health via epigenetic mechanisms.
Wi-Fi - EMFs
Disruption of the VGCC.
Leaky Barriers
leaky gut
How Cell Phones and Wireless Routers Mess Up Your Gut
July 11, 2016 Rob EMF, Microbiome, Research
Microbiota
Dysbiosis
VDR deactivation
Ligand from pathogens
1400 genes out of order
Innate immunity
Down regulation
Resistant pathogens
chronic illness
Adaptive immunity
Up regulation
Chronic inflammation
Antibodies formation
Auto immune disorders
Example to show how the causes of Lifestyle diseases are
interrelated
Western lifestyle
stress, a hyper-hygienic lifestyle ,deworming
treatments at an early age, chlorinated water,
excessive antibiotic treatments, Western diet
low in fiber and high in carbs, toxins, drugs.
Microbiota – the forgotten organ
The gut microbiota is with humans from birth and affects function throughout the body.
The human body is a host to 10 - 100 trillion microbes in a symbiotic relationship.
They outnumber the human cells in the body 10 to 1.
This benefits both the microbes and their hosts, as long as the body is in a healthy
state
The human microbiota consists of a wide variety of bacteria, viruses, fungi, and other
single-celled animals that live in the body.
Over 1000 different species of microorganism making up the human microbiota.
The microbiome is the name given to all of the genes inside these microbial cells
(metagenome).
Microbiota the forgotten
organ
What are the gut microbiota and human microbiome?
By Markus MacGill - Reviewed by Saurabh (Seth) Sethi, MD MPH
Last updated Tue 26 June 2018
The microorganisms living inside the gastrointestinal tract amount to around
4 pounds of biomass. Every individual has a unique mix of species.
The microbiota is important for nutrition, immunity, and effects on the brain
and behavior.
It is implicated in a number of diseases that cause a disturbance in the normal
balance of microbes.
The biggest populations of microbes reside
in the gut. Other popular habitats include the
skin and genitals.
The microbial cells and their genetic
material, the microbiome, live with humans
from birth. This relationship is vital to normal
health.
Microbiota – the forgotten organ
The Gut Microbiota
Complex community of microbes estimated to contain:
1- 200 trillion cells
2- > 1000 diverse microbial species
3- 10 times the number of human cells in our body
4- Gut Microbiome is 150 times larger than the human
genome
5- 100 to 1,000 times more DNA than ours!!!
6- 20,000 functions & make 100’s of thousands of
biochemicals
7- Genes for making hormones, enzymes, etc. (Humans =
23,000 - Microbes = 4.5 million)
8- Found even in “sterile” zones (e.g. lungs & womb)
1- Prevents colonization by pathogens
2- “Educates and Modulate the immune
system” Immunomodulatory cell signaling
3- Epigenomic expression e.g., butyrate
and histone deacetylase inhibition
4- Metabolic role
- Digestion-caloric extraction
- Produces
• SCFA short chain fatty acids (hypertension)
• Gut hormones/permeability
• Vitamin modification Vit K and folate
5- Participates in drug metabolism
• Activates 5-ASA 5-amino-salicylic
acid (colorectal cancer protection)
6- Deconjugates bile acids – Detoxification
7- Cytokine modulation – insulin/leptin
8- 99% genome from microbes
9- Neurotransmitters - Talk to the vagus nerve
Gut Microbiota
Functions
Dysbiosis is any perturbation of the normal microbiome content that could disrupt
the symbiotic relationship between the host and associated microbes,
a disruption that can result in diseases, such as inflammatory bowel disease and
other gastrointestinal (GI) disorders, including gastritis, peptic ulcer disease,
irritable bowel syndrome, and even gastric and colon cancer [3–6].
From: The Microbiota in Gastrointestinal Pathophysiology, 2017
Dysbiosis
Microbial Imbalance Inside the Body
Types of dysbiosis are:
1) Loss of beneficial bacteria
2) Overgrowth of potentially
pathogenic bacteria
3) Loss of overall bacterial
diversity
A gut out of balance means a body out of
balance which means illness
• Inflammation
• Allergies
• Infections
• Nutrient deficiencies
• Weight Gain
• Asthma-allergies – Autoimmunity
• Arthritis
• Metabolic Bone disease
• Skin problems e.g. eczema, rosacia
• Mood disorders - Cognitive decline-
Alzheimers
• Cancer
A gut out of balance means a body out of balance
which means illness
Gut dysbiosis may contribute to psoriatic arthritis by
overgrowth of inflammatory strains of bacteria and
yeasts, by reduction of tolerogenic strains including F.
prausnitzii , or by a combination of both
Source publication
Figure 1. Speculated health implications of gut microbiota. NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic
steatohepatitis; HS, hepatic steatosis; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; UC, ulcerative colitis.
What can alter or damage
Gut Flora
Causes of Dysbiosis
Vitamin D deficient function
(ligand – Receptor VDR)
Western life style
Antibiotics
Steroids
Birth control pills
Other Drugs, NSAID -Aspirin
Stress
Poor Diet sugar – processed
Infections
Diseases
Bottle Feeding
Old Age Extreme age
Immune suppression
Pollution
Radiation EMFs
Alcohol
Toxic Chemicals
Poor dental hygiene
Dental Work (mercury)
Abbreviations:
(TLR4) Toll-like receptor 4
(LPS) Lipopolysaccharide
(SAT) Subcutaneous adipose
tissue
(VAT) visceral adipose tissue
(PGC-1α( Peroxisome
proliferator-activated receptor
gamma coactivator 1-alpha is
a protein ... a key regulator of
energy metabolism
(FIAF) Fasting-Induced
Adipose Factor or ANGPTL4,
a protein that inhibits (LPL)
(LPL) lipoprotein lipase
(SCFAs) Short chain fatty
acids
(NNS) Non nutricious
sweetner
(SIBO) small intestinal
bacterial overgrowth
(NASH) Nonalcoholic
steatohepatitis
(FFA) free fatty acids
Dysbiosis, SIBO, Increased Intestinal Permeability (leaky gut)
Obesity – Diabetes – Cardiovascular risk – Cancer - etc
Example: Bacterial
Dysbiosis
Auto immunity simplified explanation
Dysbiosis can cause VDR deactivation
Microbiota Dysbiosis
Leaky gut
VDR deactivation
Ligand from pathogens
Innate immunity
Down regulation
Resistant pathogens
chronic illness
Adaptive immunity
Up regulation
Chronic inflammation
Antibodies formation
Auto immune disorders
Metagenome
Varies chronic diseases
symptomology including
The Fungal Mycobiome
and Its Interaction with Gut Bacteria in the Host
Qi Hui Sam,1 Matthew Wook Chang,2,3 and Louis Yi Ann Chai1,4,*
Patrick C. Y. Woo, Academic Editor Int J Mol Sci. 2017 Feb; 18(2): 330. Published online 2017 Feb 4. doi: 10.3390/ijms18020330
PMCID: PMC5343866 - PMID: 28165395
Figure 1. The multifaceted factors influencing gut microbiome and mycobiome interaction.
DNA sequencing
Solved the problem of negative cultures
It includes any method or technology that is used to
determine the order of the four bases: adenine, guanine,
cytosine, and thymine.
The advent of rapid DNA sequencing methods has greatly
accelerated biological and medical research and
discovery.
The advent of sequencing technology has endowed us with the capacity to study microbes
constituting the human commensal community that were previously non-culturable. Much of the
initial works have concentrated on the bacterial flora constituting the gut microbiome, since
specimens are readily accessible in health and disease. Less, however, is understood of the
“silent population”—the fungal species, also known as the mycobiome. Living in
symbiosis with bacteria as commensals in our body, it is perceivable that the mycobiome exerts
an inadvertent influence on the microbiome. We review here the recent knowledge gained from
study of the interaction between the mycobiome and microbiome in health and disease
susceptibility, immunity, and consequences from antimicrobial
Example: Fungal
Dysbiosis
Systemic Candidiasis
The most common causes of increased risk for candida
overgrowth include:
•Immunocompromized (for example, people who have had an
organ transplant, have HIV/AIDS, or are
on cancer chemotherapy)
•Medications such as broad-spectrum antibiotics
•High stress lifestyle
•Oral contraceptives
•Dietary : refined sugars and carbohydrates
•Cancer treatments
•Oral corticosteroids
•Intensive care unit (ICU) patients
•People who have had surgery,
especially gastrointestinal surgery
•People who have a central venous catheter
•Very low-birth-weight infants
•People who have a very low neutrophil (a type of white blood
cell) count (neutropenia)
•People who have kidney failure or are on hemodialysis
•People who have diabetes
Systemic candidiasis includes a spectrum of yeast infections caused by different species (types)
of Candida
It is a serious infection that can affect the blood, heart, brain, eyes, bones, or other parts of the body
Although there are over 200 species of Candida, five different species of Candida cause 90% of
systemic candidiasisl:
The most common form of this invasive yeast infection is when Candida enters the bloodstream
(candidemia).
Signs of candidemia include fever and chills that do not improve with antibiotics.
Candidemia can cause septic shock and therefore may include symptoms such as low
blood pressure, fast heart rate, and rapid breathing
Symptoms of other types of systemic candidiasis depend on the organ or system which is infected.
central nervous system (brain and spinal cord), abdomen, heart, kidneys, liver, bones, muscles, joints,
spleen, and/or eyes. Candidemia may be present, but not in all cases.
Systemic candidiasis is the most common fungal infection among hosptilized people in high-income
countries, including the United States.
Diagnosis can be difficult, especially when the Candida is not found in the bloodstream
Treatment usually includes consists of oral or intravenous (IV) antifungal medications
Last updated: 12/15/2016
Systemic Candidiasis
Effectively treating Candida involves
1- stopping the overgrowth,
2- restoring the friendly bacteria that usually keep them in
check,
3- repairing your gut so that Candida can no longer enter your
bloodstream.
I accomplish this with a simple and proven three-wave attack in
my 30-day Candida Breakthrough® Program. The steps are as
follows:
•Step 1: First, you need to starve the Candida by removing the
foods that feed it from your diet. This means cutting
all sugar and alcohol, and limiting carbohydrates such as fruit,
starchy vegetables, grains, and legumes.
•Step 2: Next, you’ll want to attack the Candida by taking
supplements that destroy Candida’s cell walls. I like to
useCandifense™ as well as Caprylic Acid, both of which are
excellent at breaking down the walls of Candida cells.
•Step 3: Finally, you will repopulate your gut with good bacteria
using a high-potency probiotic to keep Candida under control.
While battling Candida, I recommend a probiotic supplement
containing 100 billion colony-forming units (CFUs) to restore
your gut’s healthy microbial balance.
How do you treat Candida overgrowth?
Dysbiosis
Management
lifestyle interventions to restore balance
and health to the gut microbiome
What causes alterations of the
human microbiome
• Dietary changes : e.g. refined, processed simple starches and
sugars “carbohydrate-dense” foods
• Marked decreases in fermentable fiber
• Antibiotic use: in prescriptions and in industrialized foods
• Glyphosate: as broad-spectrum systemic herbicide . It is applied to the
leaves of plants to kill both broadleaf plants and grasses. Glyphosate is
organophosphorus compound used to regulate plant growth and ripen
fruit. Glyphosate was first registered for use in the U.S. in 1974.
• Hygiene hypothesis
• Prior GI infections; H. pylori; systemic infections SIBO-small
intestinal bacterial overgrowth
• Medications: e.g. PPIs, steroids, chemotherapy
5-R Program Goal for digestive health is
to accomplish the following:
1- To address dietary and lifestyle issues,
and to begin the process of dietary
education and change.
2- To normalize digestion and absorption.
3- To normalize the balance of
gastrointestinal bacteria.
4- To promote a balanced system of
detoxification.
5- To promote gastrointestinal healing.
5-R Program Elements for digestive health are
described briefly below.
1- Remove: Remove stressors: get rid of things that negatively
affect the environment of the GI tract including allergic foods,
parasites or other bad bugs such as bacteria or yeast. This might
involve using an allergy “elimination diet” to find out what foods are
causing GI symptoms or it may involve taking drugs or herbs to
eradicate a particular bug.
2- Replace: Replace digestive secretions: add back things like
digestive enzymes, hydrochloric acid and bile acids that are required
for proper digestion and that may be compromised by diet, drugs,
diseases, aging, or other factors.
3- Reinoculate: Help beneficial bacteria flourish by taking in
probiotic foods or supplements that contain the so-called “good”
bacteria such as bifidobacteria and lactobacillus species, and by
consuming the high soluble fiber foods that good bugs like to eat,
called “prebiotics.”
4- Repair: Help the lining of the GI tract repair itself by supplying
key nutrients that can often be in short supply in a disease state,
such as zinc, antioxidants (e.g. vitamins A, C, and E), fish oil, and the
amino acid glutamine.
5- Rebalance: Pay attention to lifestyle choices – sleep, exercise
and stress can all affect the GI tract.
Microbiota Accessible Carbohydrates
Soluble fibers
• Fruits and vegetables e.g. apples, pears, berries, carrots,
squash, zucchini, sweet potato
Non-starch polysaccharides
• Long chain carbohydrates that are not starch e.g. onions,
garlic, Jerusalem artichoke, leeks
Resistant starch
• Non-soluble fiber e.g. beans, legumes, lentils, cooked-
cooled potatoes, plantains
Microbiota-accessible carbohydrates (MACs) are carbohydrates that are resistant to digestion by a host's metabolism, and
are made available for gut microbes, as prebiotics, to ferment or metabolize into beneficial compounds, such as short chain fatty
acids.
Courtesy Kathie Swift MS RDN LDN FAND EBQ
Courtesy Kathie Swift MS RDN LDN FAND EBQ
• In animal models, giving VSL#3 probiotics modulates
microbiota induction of butyrate and GLP-1.
• These metabolic changes enhance insulin signaling,
increase fat oxidation, decrease appetite, improve colonic
epithelial function-integrity and barrier function.
Am J Clin Nutr 2006;84:556–60
• Fasting GLP-1 levels were associated with higher rates of
TEE (24-h total energy expenditure) and fat oxidation,
independent of age, sex and body composition.
Conclusion: This study provides evidence that total daily energy expenditure,
resting metabolic rate, substrate oxidation, and total energy intake are predictors
of gain in body fatness during late childhood in boys and girls.
Understanding the factors that promote ingested fat oxidation could lead to
more effective obesity intervention programs.
• Multi-center, double-blinded randomized, placebo-controlled
intervention trial
• 87 subjects with high BMI and VAT
• FM vs. placebo for 12 weeks
• Improved wt. loss and body comp in treated group
compared with control
• Higher adiponectin in treated group. Enhanced insulin
sensitivity, glucose regulation and fat oxidation
• Greater fecal fat excretion seen in those supplemented with
L. gasseri. This effect was mediated by suppression of
lipase-mediated lipid absorption.
• Different Lactobacillus species appear to have varied
effects on metabolism and weight loss.
• Review of 17 RCTs in human adults reveal positive effects
with L plantarum and L gasseri with weight gain with L
acidophilus.
• Multi-center, double-blinded randomized, placebo-controlled
intervention trial
• 87 subjects with high BMI and VAT
• FM vs. placebo for 12 weeks
• Improved wt. loss and body comp in treated group compared
with control
• Higher adiponectin in treated group. Enhanced insulin
sensitivity, glucose regulation and fat oxidation
• Intervention with FM in 210 healthy overweight adults.
• Significant lowering of abdominal adiposity was seen.
• Effects were reversed after discontinuation of FM
Courtesy Kathie Swift MS RDN LDN FAND EBQ
Food Additives: Emulsifiers. Oil and water don't mix — until an emulsifying agent
is added. Emulsifiers made from plant, animal and synthetic sources commonly
are added to processed foods such as mayonnaise, ice cream and baked goods to
create a smooth texture, prevent separation and extend shelf life. Nov 1, 2017
Lifestyle changes to bring diversity and
balance to the gut microbiome
• Diminish sugar and processed refined, carbohydrate-dense foods. Grains, gluten
and glyphosate exposures
• Increase fermentable plant-based fiber and fermentable foods
• Biodiversity in food and feed.
• Fermented foods containing lactobacilli : include many ancient staples,
ranging from
fermented milk, yogurt, cheese and wine to olives,pickles, sauerkraut, sourdo
ugh bread, fermented sausages and salami, as well as silage and recent
probiotic dairy products.Apr 7, 2006
• foods containing bifidobacteria : Eat whole grains: Whole grains such as
oats and barley are very good for gut health and can help increase intestinal
Bifidobacteria (43, 44). Eat fermented foods: Fermented foods such
as yogurt and kimchi contain healthy bacteria.Jul 25, 2017
• Whenever possible, go organic, GMO-free (glyphosate)
• Cautious with prescribed antibiotics and feed lot meats,
poultry, and eggs
• Minimize NNS non-nutritive sweeteners, emulsifiers,
thickeners
• Consider: testing, diagnosis and treatment of dysbiosis-
SIBO (SIBO breath testing; Complete Digestive Stool
Analysis (CDSA) ; H. pylori)
• Probiotics
• Taper, d/c PPIs
• ? Future of fecal microbiota transplants
Lifestyle changes to bring diversity and
balance to the gut microbiome
"Let thy food be thy medicine and thy medicine be thy food"
Hippocrates 460 BC - 370 BC
"No illness which can be treated by diet should be treated by any
other means”
Moses Maimonides, the great
12th century physician
Do not treat food with medicine, Let the food be the medicine, and the
Medicine be the food
Dr. Sarah Hallberg May 4, 2015
What are the gut microbiota and human microbiome?
By Markus MacGill - Reviewed by Saurabh (Seth) Sethi, MD MPH
Last updated Tue 26 June 2018
Tomorrow's Medicine
‫قوع‬ ‫م‬ ‫وس‬ ‫ه‬ َ ‫هللا‬ ‫ل‬ ‫ص‬ ‫هللا‬ ‫رسوع‬‫آدن‬ ‫نأل‬ ‫نا‬،‫بطن‬ ‫نن‬ ‫شرا‬ ‫وَاء‬‫قنن‬ ‫أكَلت‬ ‫آدم‬ ‫ابن‬ ‫بحسب‬
‫به‬ ‫ص‬‫لنفسه‬ ‫ث‬ ‫وث‬ ‫لشرابه‬ ‫ث‬ ‫وث‬ ‫لطعانه‬ ‫ث‬ ‫فث‬ ‫نحالة‬ ‫َل‬ ‫كان‬ ‫فإن‬ ،.
‫رواه‬‫ي‬ ‫الترن‬‫وصححه‬‫اْللبان‬
Messenger of Allah ( ‫ﷺ‬) say: "No man fills a container worse than his stomach. A
few morsels that keep his back upright are sufficient for him. If he has to, then
he should keep one-third for food, one-third for drink and one-third for his
breathing.“ [At-Tirmidhi].
‫هللا‬ ‫ل‬ ‫ص‬ ‫هللا‬ ‫رسوع‬
‫م‬ ‫وس‬ ‫ه‬ َ
Main references:
How epigenetics, our gut microbiome and the environment interact to change our lives
Ben Locwin | Genetic Literacy Project | October 17, 2016
Health and the Gut Microbiome: Restoring a Lost Legacy
Mark Pettus MD. Director of Medical Education and Population Health. Berkshire Health
Systems. March 27, 2017
The Fungal Mycobiota: Small Numbers, Large Impacts
Carol A. Kumamoto1,*
1Department of Molecular Biology and Microbiology, Tufts University, 150 Harrison Avenue,
Boston, MA 02111, USA
*Correspondence: carol.kumamoto@tufts.edu
http://dx.doi.org/10.1016/j.chom.2016.05.018
Fungal dysbiosis: immunity and interactions at mucosal barriers
Iliyan D. Iliev
1,2,3
and Irina Leonardi
1,3
Nat Rev Immunol. 2017 Oct; 17(10): 635–646.
Published online 2017 Jun 12. doi: 10.1038/nri.2017.55
The Fungal Mycobiome and Its Interaction with Gut Bacteria in the Host
Qi Hui Sam 1
,Matthew Wook Chang 2,3
Int. J. Mol. Sci. 2017, 18(2), 330; doi:10.3390/ijms18020330
Systemic candidiasis Other Names: Systemic candida infections; Invasive Candidiasis
Genetic and Rare Diseases Information Center (GARD)
Role of intestinal microbiota and metabolites on gut homeostasis and human diseases
Lan Lin1*Lin and Zhang BMC Immunology (2017) 18:2
DOI 10.1186/s12865-016-0187-3
Immunological Consequences of Intestinal Fungal Dysbiosis
Matthew L. Wheeler,1 Jose J. Limon,1 Agnieszka S. Bar,1,6 Christian A. Leal,1 Matthew
Gargus,1 Jie Tang,2 Jordan Brown,2
Vincent A. Funari,2 Hanlin L. Wang,3 Timothy R. Crother,4 Moshe Arditi,4 David M.
Underhill,1,3,5,* and Iliyan D. Iliev1,5,6,*
The Mycobiome: A Neglected Component in the Microbiota-Gut-Brain Axis
Raphaël Enaud 1,2,3,*, Louise-Eva Vandenborght 1,3,4, Noémie Coron 1,2,3, Thomas Bazin
1,2, enaud Prevel 1, Thierry Schaeverbeke 1,2, Patrick Berger 1,2,3, Michael Fayon 1,2,3,
Thierry Lamireau 1,2 ID and Laurence Delhaes 1,2,3
Received: 5 February 2018; Accepted: 5 March 2018; Published: 9 March 2018
Role of the gut microbiota in nutrition and health
Article (PDF Available) in BMJ Clinical Research 361:k2179 · June 2018 with 286 Reads
DOI: 10.1136/bmj.k2179
JB Review J Biochem 127, 717-722 2000: The Function of Vitamin D Receptor in
Vitamin D Action
Shigeaki Kato Institute of Molecular and Cellular Biosciencex The University of Tokyo, Yavoi-
cho, Bunkyo-ku, Tokyo, 113-0032; and CREST, Japan Science and Technology Corporation,
41-8 Honcho, Kawaguchi, Saitama 332 Received January 21, 2000; accepted January 28,
2000
Dysbiosis

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Dysbiosis

  • 1. Dr. Fathi Neana, MD Chief of Orthopaedics Dr. Fakhry & Dr. A. Al-Garzaie Hospital February, 21 - 2019 D Y S B I O S I S
  • 2.
  • 3.
  • 4. Diversity and Biodiversity Biological diversity, or biodiversity, is the scientific term for the variety and variability of life on Earth. Biodiversity is the key indicator of the health of an ecosystem. Every living thing, including man, is involved in these complex networks of interdependent relationships, which are called ecosystems.
  • 5. Diversity and Biodiversity Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity is a common finding in several disease states. Microbiota Biodiversity helps us : 1- Combat aggressions from other microorganisms, 2- Maintaining the wholeness of the intestinal mucosa. 3- Plays an important role in the immune system, 4- Performing a barrier effect. 5- A healthy and balanced gut microbiota is key to ensuring proper digestive functioning.
  • 6. ٍ‫ض‬ْ‫ع‬َ‫ب‬ِ‫ب‬ ‫م‬ُ‫ه‬َ‫ض‬ْ‫ع‬َ‫ب‬ َ‫اس‬‫ه‬‫ن‬‫ال‬ ِ ‫ه‬‫اَّلل‬ ُ‫ع‬ْ‫َف‬‫د‬ َ‫وَل‬َ‫ل‬َ‫و‬ُ‫ض‬ْ‫ر‬َ ْ‫اْل‬ ِ‫ت‬َ‫د‬َ‫س‬َ‫ف‬‫ه‬‫ل‬َ ‫ه‬‫اَّلل‬ ‫ه‬‫ن‬ِ‫ك‬ََٰ‫ل‬َ‫و‬َ‫ن‬ ِ‫ن‬َ‫ل‬‫ا‬َ‫ع‬ْ‫ل‬‫ا‬ ‫ل‬َ ََ ٍ‫ع‬ْ‫ض‬َ‫ف‬ ‫و‬ُ(251)‫ا‬ ‫سورة‬‫لبقرة‬ And if Allah had not repelled some men by others the earth would have been corrupted. But Allah is a Lord of Kindness to (His) creatures. Sura Al- Baqara: Verse 25 ِ‫ض‬ْ‫ر‬َ ْ‫اْل‬َ‫و‬ ِ‫ت‬‫ا‬َ‫او‬َ‫ن‬‫ه‬‫س‬‫ال‬ ُ‫ق‬ْ َ‫خ‬ ِ‫ه‬ِ‫ت‬‫ا‬َ ‫آ‬ ْ‫ن‬ِ‫ون‬ۚ ْ‫م‬ُ‫ك‬ِ‫ن‬‫ا‬َ‫و‬ْ‫ل‬َ‫أ‬َ‫و‬ ْ‫م‬ُ‫ك‬ِ‫ت‬َ‫ن‬ِ‫س‬ْ‫ل‬َ‫أ‬ ُ‫ف‬ َ‫َل‬ِ‫ت‬ْ‫اخ‬َ‫و‬َِِ‫ن‬ ِ‫ن‬ِ‫ل‬‫ا‬َ‫ع‬ْ ِ‫ل‬‫ل‬ ٍ‫ت‬‫ا‬َ ََ ََِ‫ل‬ََٰ ِ‫ف‬ ‫ه‬‫ن‬(22.)‫الروم‬ ‫سورة‬ And among His Signs is the creation of the heavens and the earth, and the variations in your languages and your colours: verily in that are Signs for those who know. Ar-Room: Verse 22 Diversity is a rule that govern our life on earth
  • 7.
  • 8. How epigenetics, our gut microbiome and the environment interact to change our lives Ben Locwin | Genetic Literacy Project | October 17, 2016 Research presented at the American Association for the Advancement of Science 2014 conference 1- Supported that epigenetics and some form of heritability are in fact linked. 2- Much of our lives and life trajectories could, in fact, reflect a sensitive interplay between our environment, genes (epigenetics) and microbiome 3- The intersection of all of these factors is, quite simply, ‘us.’ as in the Venn diagram 1- Children raised in more rural areas (more exposure to animals, dirt, debris, molds, pollen, etc.) suffer from fewer cases of allergies than those children raised in more urban settings. Again, that pattern suggests an interplay of our external environment, microbiome, and epigenetics. 2- Some novel research indicates that certain compounds produced by certain gut flora can make colon cancer more prevalent by blocking the activity of DNA repair proteins. 3- The composition of the gut microflora can be changed very ‘rapidly and reproducibly’ in response to dietary changes. Some of the consequences are directly due to microbial gene expression. 4- The inflammatory cascade of Crohn’s disease seems to be related to the gut microbiome and specific microbes in particular.
  • 9.
  • 11. An epigenome consists of a record of the chemical changes to the DNA and histone proteins of an organism These changes can be passed down to an organism's offspring via transgenerational epigenetic inheritance. Wikipedia 1- The epigenome is highly sensitive to external environmental factors in early life, such as nutrition, stress, endocrine disruption and pollution Epigenetics, Gut microbiome and the Environment a sensitive interplay 2- The epigenome is highly sensitive to internal environmental (Microbiota) 3- The changes in the epigenome can induce long-term changes in gene expression and phenotype. 4- The external environmental factors (our environment) affects our microbiome (The internal environmental)
  • 12. Epigenetics and lifestyle Jorge Alejandro Alegría-Torres,1 Andrea Baccarelli,2 and Valentina Bollati3,* Epigenomics. Author manuscript; available in PMC 2013 Aug 26. Published in final edited form as: Epigenomics. 2011 Jun; 3(3): 267–277. doi: 10.2217/epi.11.22 PMCID: PMC3752894 NIHMSID: NIHMS498542 PMID: 22122337 The concept of “lifestyle” includes different factors such as nutrition, behavior, stress, physical activity, working habits, smoking and alcohol consumption. Increasing evidence shows that environmental and lifestyle factors may influence epigenetic mechanisms, such as DNA methylation, histone acetylation and microRNA expression. Several lifestyle factors have been identified that might modify epigenetic patterns, such as diet, obesity, physical activity, tobacco smoking, alcohol consumption, environmental pollutants, psychological stress, and working on night shifts. Most studies conducted so far have been centered on DNA methylation, whereas only a few investigations have studied lifestyle factors in relation to histone modifications and miRNAs. Here, we review current evidence indicating that lifestyle factors might affect human health via epigenetic mechanisms.
  • 13. Wi-Fi - EMFs Disruption of the VGCC. Leaky Barriers leaky gut How Cell Phones and Wireless Routers Mess Up Your Gut July 11, 2016 Rob EMF, Microbiome, Research Microbiota Dysbiosis VDR deactivation Ligand from pathogens 1400 genes out of order Innate immunity Down regulation Resistant pathogens chronic illness Adaptive immunity Up regulation Chronic inflammation Antibodies formation Auto immune disorders Example to show how the causes of Lifestyle diseases are interrelated Western lifestyle stress, a hyper-hygienic lifestyle ,deworming treatments at an early age, chlorinated water, excessive antibiotic treatments, Western diet low in fiber and high in carbs, toxins, drugs.
  • 14. Microbiota – the forgotten organ
  • 15. The gut microbiota is with humans from birth and affects function throughout the body. The human body is a host to 10 - 100 trillion microbes in a symbiotic relationship. They outnumber the human cells in the body 10 to 1. This benefits both the microbes and their hosts, as long as the body is in a healthy state The human microbiota consists of a wide variety of bacteria, viruses, fungi, and other single-celled animals that live in the body. Over 1000 different species of microorganism making up the human microbiota. The microbiome is the name given to all of the genes inside these microbial cells (metagenome). Microbiota the forgotten organ What are the gut microbiota and human microbiome? By Markus MacGill - Reviewed by Saurabh (Seth) Sethi, MD MPH Last updated Tue 26 June 2018
  • 16. The microorganisms living inside the gastrointestinal tract amount to around 4 pounds of biomass. Every individual has a unique mix of species. The microbiota is important for nutrition, immunity, and effects on the brain and behavior. It is implicated in a number of diseases that cause a disturbance in the normal balance of microbes. The biggest populations of microbes reside in the gut. Other popular habitats include the skin and genitals. The microbial cells and their genetic material, the microbiome, live with humans from birth. This relationship is vital to normal health.
  • 17. Microbiota – the forgotten organ The Gut Microbiota Complex community of microbes estimated to contain: 1- 200 trillion cells 2- > 1000 diverse microbial species 3- 10 times the number of human cells in our body 4- Gut Microbiome is 150 times larger than the human genome 5- 100 to 1,000 times more DNA than ours!!! 6- 20,000 functions & make 100’s of thousands of biochemicals 7- Genes for making hormones, enzymes, etc. (Humans = 23,000 - Microbes = 4.5 million) 8- Found even in “sterile” zones (e.g. lungs & womb)
  • 18. 1- Prevents colonization by pathogens 2- “Educates and Modulate the immune system” Immunomodulatory cell signaling 3- Epigenomic expression e.g., butyrate and histone deacetylase inhibition 4- Metabolic role - Digestion-caloric extraction - Produces • SCFA short chain fatty acids (hypertension) • Gut hormones/permeability • Vitamin modification Vit K and folate 5- Participates in drug metabolism • Activates 5-ASA 5-amino-salicylic acid (colorectal cancer protection) 6- Deconjugates bile acids – Detoxification 7- Cytokine modulation – insulin/leptin 8- 99% genome from microbes 9- Neurotransmitters - Talk to the vagus nerve Gut Microbiota Functions
  • 19.
  • 20. Dysbiosis is any perturbation of the normal microbiome content that could disrupt the symbiotic relationship between the host and associated microbes, a disruption that can result in diseases, such as inflammatory bowel disease and other gastrointestinal (GI) disorders, including gastritis, peptic ulcer disease, irritable bowel syndrome, and even gastric and colon cancer [3–6]. From: The Microbiota in Gastrointestinal Pathophysiology, 2017 Dysbiosis Microbial Imbalance Inside the Body Types of dysbiosis are: 1) Loss of beneficial bacteria 2) Overgrowth of potentially pathogenic bacteria 3) Loss of overall bacterial diversity
  • 21.
  • 22. A gut out of balance means a body out of balance which means illness • Inflammation • Allergies • Infections • Nutrient deficiencies • Weight Gain • Asthma-allergies – Autoimmunity • Arthritis • Metabolic Bone disease • Skin problems e.g. eczema, rosacia • Mood disorders - Cognitive decline- Alzheimers • Cancer
  • 23.
  • 24. A gut out of balance means a body out of balance which means illness Gut dysbiosis may contribute to psoriatic arthritis by overgrowth of inflammatory strains of bacteria and yeasts, by reduction of tolerogenic strains including F. prausnitzii , or by a combination of both Source publication
  • 25.
  • 26. Figure 1. Speculated health implications of gut microbiota. NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; HS, hepatic steatosis; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; UC, ulcerative colitis.
  • 27. What can alter or damage Gut Flora Causes of Dysbiosis Vitamin D deficient function (ligand – Receptor VDR) Western life style Antibiotics Steroids Birth control pills Other Drugs, NSAID -Aspirin Stress Poor Diet sugar – processed Infections Diseases Bottle Feeding Old Age Extreme age Immune suppression Pollution Radiation EMFs Alcohol Toxic Chemicals Poor dental hygiene Dental Work (mercury)
  • 28.
  • 29.
  • 30. Abbreviations: (TLR4) Toll-like receptor 4 (LPS) Lipopolysaccharide (SAT) Subcutaneous adipose tissue (VAT) visceral adipose tissue (PGC-1α( Peroxisome proliferator-activated receptor gamma coactivator 1-alpha is a protein ... a key regulator of energy metabolism (FIAF) Fasting-Induced Adipose Factor or ANGPTL4, a protein that inhibits (LPL) (LPL) lipoprotein lipase (SCFAs) Short chain fatty acids (NNS) Non nutricious sweetner (SIBO) small intestinal bacterial overgrowth (NASH) Nonalcoholic steatohepatitis (FFA) free fatty acids Dysbiosis, SIBO, Increased Intestinal Permeability (leaky gut) Obesity – Diabetes – Cardiovascular risk – Cancer - etc
  • 32. Auto immunity simplified explanation Dysbiosis can cause VDR deactivation Microbiota Dysbiosis Leaky gut VDR deactivation Ligand from pathogens Innate immunity Down regulation Resistant pathogens chronic illness Adaptive immunity Up regulation Chronic inflammation Antibodies formation Auto immune disorders Metagenome Varies chronic diseases symptomology including
  • 33. The Fungal Mycobiome and Its Interaction with Gut Bacteria in the Host Qi Hui Sam,1 Matthew Wook Chang,2,3 and Louis Yi Ann Chai1,4,* Patrick C. Y. Woo, Academic Editor Int J Mol Sci. 2017 Feb; 18(2): 330. Published online 2017 Feb 4. doi: 10.3390/ijms18020330 PMCID: PMC5343866 - PMID: 28165395 Figure 1. The multifaceted factors influencing gut microbiome and mycobiome interaction.
  • 34. DNA sequencing Solved the problem of negative cultures It includes any method or technology that is used to determine the order of the four bases: adenine, guanine, cytosine, and thymine. The advent of rapid DNA sequencing methods has greatly accelerated biological and medical research and discovery. The advent of sequencing technology has endowed us with the capacity to study microbes constituting the human commensal community that were previously non-culturable. Much of the initial works have concentrated on the bacterial flora constituting the gut microbiome, since specimens are readily accessible in health and disease. Less, however, is understood of the “silent population”—the fungal species, also known as the mycobiome. Living in symbiosis with bacteria as commensals in our body, it is perceivable that the mycobiome exerts an inadvertent influence on the microbiome. We review here the recent knowledge gained from study of the interaction between the mycobiome and microbiome in health and disease susceptibility, immunity, and consequences from antimicrobial
  • 36. Systemic Candidiasis The most common causes of increased risk for candida overgrowth include: •Immunocompromized (for example, people who have had an organ transplant, have HIV/AIDS, or are on cancer chemotherapy) •Medications such as broad-spectrum antibiotics •High stress lifestyle •Oral contraceptives •Dietary : refined sugars and carbohydrates •Cancer treatments •Oral corticosteroids •Intensive care unit (ICU) patients •People who have had surgery, especially gastrointestinal surgery •People who have a central venous catheter •Very low-birth-weight infants •People who have a very low neutrophil (a type of white blood cell) count (neutropenia) •People who have kidney failure or are on hemodialysis •People who have diabetes
  • 37. Systemic candidiasis includes a spectrum of yeast infections caused by different species (types) of Candida It is a serious infection that can affect the blood, heart, brain, eyes, bones, or other parts of the body Although there are over 200 species of Candida, five different species of Candida cause 90% of systemic candidiasisl: The most common form of this invasive yeast infection is when Candida enters the bloodstream (candidemia). Signs of candidemia include fever and chills that do not improve with antibiotics. Candidemia can cause septic shock and therefore may include symptoms such as low blood pressure, fast heart rate, and rapid breathing Symptoms of other types of systemic candidiasis depend on the organ or system which is infected. central nervous system (brain and spinal cord), abdomen, heart, kidneys, liver, bones, muscles, joints, spleen, and/or eyes. Candidemia may be present, but not in all cases. Systemic candidiasis is the most common fungal infection among hosptilized people in high-income countries, including the United States. Diagnosis can be difficult, especially when the Candida is not found in the bloodstream Treatment usually includes consists of oral or intravenous (IV) antifungal medications Last updated: 12/15/2016 Systemic Candidiasis
  • 38.
  • 39.
  • 40. Effectively treating Candida involves 1- stopping the overgrowth, 2- restoring the friendly bacteria that usually keep them in check, 3- repairing your gut so that Candida can no longer enter your bloodstream. I accomplish this with a simple and proven three-wave attack in my 30-day Candida Breakthrough® Program. The steps are as follows: •Step 1: First, you need to starve the Candida by removing the foods that feed it from your diet. This means cutting all sugar and alcohol, and limiting carbohydrates such as fruit, starchy vegetables, grains, and legumes. •Step 2: Next, you’ll want to attack the Candida by taking supplements that destroy Candida’s cell walls. I like to useCandifense™ as well as Caprylic Acid, both of which are excellent at breaking down the walls of Candida cells. •Step 3: Finally, you will repopulate your gut with good bacteria using a high-potency probiotic to keep Candida under control. While battling Candida, I recommend a probiotic supplement containing 100 billion colony-forming units (CFUs) to restore your gut’s healthy microbial balance. How do you treat Candida overgrowth?
  • 41. Dysbiosis Management lifestyle interventions to restore balance and health to the gut microbiome
  • 42. What causes alterations of the human microbiome • Dietary changes : e.g. refined, processed simple starches and sugars “carbohydrate-dense” foods • Marked decreases in fermentable fiber • Antibiotic use: in prescriptions and in industrialized foods • Glyphosate: as broad-spectrum systemic herbicide . It is applied to the leaves of plants to kill both broadleaf plants and grasses. Glyphosate is organophosphorus compound used to regulate plant growth and ripen fruit. Glyphosate was first registered for use in the U.S. in 1974. • Hygiene hypothesis • Prior GI infections; H. pylori; systemic infections SIBO-small intestinal bacterial overgrowth • Medications: e.g. PPIs, steroids, chemotherapy
  • 43. 5-R Program Goal for digestive health is to accomplish the following: 1- To address dietary and lifestyle issues, and to begin the process of dietary education and change. 2- To normalize digestion and absorption. 3- To normalize the balance of gastrointestinal bacteria. 4- To promote a balanced system of detoxification. 5- To promote gastrointestinal healing.
  • 44. 5-R Program Elements for digestive health are described briefly below. 1- Remove: Remove stressors: get rid of things that negatively affect the environment of the GI tract including allergic foods, parasites or other bad bugs such as bacteria or yeast. This might involve using an allergy “elimination diet” to find out what foods are causing GI symptoms or it may involve taking drugs or herbs to eradicate a particular bug. 2- Replace: Replace digestive secretions: add back things like digestive enzymes, hydrochloric acid and bile acids that are required for proper digestion and that may be compromised by diet, drugs, diseases, aging, or other factors. 3- Reinoculate: Help beneficial bacteria flourish by taking in probiotic foods or supplements that contain the so-called “good” bacteria such as bifidobacteria and lactobacillus species, and by consuming the high soluble fiber foods that good bugs like to eat, called “prebiotics.” 4- Repair: Help the lining of the GI tract repair itself by supplying key nutrients that can often be in short supply in a disease state, such as zinc, antioxidants (e.g. vitamins A, C, and E), fish oil, and the amino acid glutamine. 5- Rebalance: Pay attention to lifestyle choices – sleep, exercise and stress can all affect the GI tract.
  • 45. Microbiota Accessible Carbohydrates Soluble fibers • Fruits and vegetables e.g. apples, pears, berries, carrots, squash, zucchini, sweet potato Non-starch polysaccharides • Long chain carbohydrates that are not starch e.g. onions, garlic, Jerusalem artichoke, leeks Resistant starch • Non-soluble fiber e.g. beans, legumes, lentils, cooked- cooled potatoes, plantains Microbiota-accessible carbohydrates (MACs) are carbohydrates that are resistant to digestion by a host's metabolism, and are made available for gut microbes, as prebiotics, to ferment or metabolize into beneficial compounds, such as short chain fatty acids.
  • 46. Courtesy Kathie Swift MS RDN LDN FAND EBQ
  • 47. Courtesy Kathie Swift MS RDN LDN FAND EBQ
  • 48. • In animal models, giving VSL#3 probiotics modulates microbiota induction of butyrate and GLP-1. • These metabolic changes enhance insulin signaling, increase fat oxidation, decrease appetite, improve colonic epithelial function-integrity and barrier function.
  • 49. Am J Clin Nutr 2006;84:556–60 • Fasting GLP-1 levels were associated with higher rates of TEE (24-h total energy expenditure) and fat oxidation, independent of age, sex and body composition. Conclusion: This study provides evidence that total daily energy expenditure, resting metabolic rate, substrate oxidation, and total energy intake are predictors of gain in body fatness during late childhood in boys and girls. Understanding the factors that promote ingested fat oxidation could lead to more effective obesity intervention programs.
  • 50.
  • 51. • Multi-center, double-blinded randomized, placebo-controlled intervention trial • 87 subjects with high BMI and VAT • FM vs. placebo for 12 weeks • Improved wt. loss and body comp in treated group compared with control • Higher adiponectin in treated group. Enhanced insulin sensitivity, glucose regulation and fat oxidation
  • 52. • Greater fecal fat excretion seen in those supplemented with L. gasseri. This effect was mediated by suppression of lipase-mediated lipid absorption.
  • 53. • Different Lactobacillus species appear to have varied effects on metabolism and weight loss. • Review of 17 RCTs in human adults reveal positive effects with L plantarum and L gasseri with weight gain with L acidophilus.
  • 54. • Multi-center, double-blinded randomized, placebo-controlled intervention trial • 87 subjects with high BMI and VAT • FM vs. placebo for 12 weeks • Improved wt. loss and body comp in treated group compared with control • Higher adiponectin in treated group. Enhanced insulin sensitivity, glucose regulation and fat oxidation
  • 55. • Intervention with FM in 210 healthy overweight adults. • Significant lowering of abdominal adiposity was seen. • Effects were reversed after discontinuation of FM
  • 56. Courtesy Kathie Swift MS RDN LDN FAND EBQ
  • 57. Food Additives: Emulsifiers. Oil and water don't mix — until an emulsifying agent is added. Emulsifiers made from plant, animal and synthetic sources commonly are added to processed foods such as mayonnaise, ice cream and baked goods to create a smooth texture, prevent separation and extend shelf life. Nov 1, 2017
  • 58. Lifestyle changes to bring diversity and balance to the gut microbiome • Diminish sugar and processed refined, carbohydrate-dense foods. Grains, gluten and glyphosate exposures • Increase fermentable plant-based fiber and fermentable foods • Biodiversity in food and feed. • Fermented foods containing lactobacilli : include many ancient staples, ranging from fermented milk, yogurt, cheese and wine to olives,pickles, sauerkraut, sourdo ugh bread, fermented sausages and salami, as well as silage and recent probiotic dairy products.Apr 7, 2006 • foods containing bifidobacteria : Eat whole grains: Whole grains such as oats and barley are very good for gut health and can help increase intestinal Bifidobacteria (43, 44). Eat fermented foods: Fermented foods such as yogurt and kimchi contain healthy bacteria.Jul 25, 2017
  • 59. • Whenever possible, go organic, GMO-free (glyphosate) • Cautious with prescribed antibiotics and feed lot meats, poultry, and eggs • Minimize NNS non-nutritive sweeteners, emulsifiers, thickeners • Consider: testing, diagnosis and treatment of dysbiosis- SIBO (SIBO breath testing; Complete Digestive Stool Analysis (CDSA) ; H. pylori) • Probiotics • Taper, d/c PPIs • ? Future of fecal microbiota transplants Lifestyle changes to bring diversity and balance to the gut microbiome
  • 60.
  • 61. "Let thy food be thy medicine and thy medicine be thy food" Hippocrates 460 BC - 370 BC "No illness which can be treated by diet should be treated by any other means” Moses Maimonides, the great 12th century physician Do not treat food with medicine, Let the food be the medicine, and the Medicine be the food Dr. Sarah Hallberg May 4, 2015 What are the gut microbiota and human microbiome? By Markus MacGill - Reviewed by Saurabh (Seth) Sethi, MD MPH Last updated Tue 26 June 2018 Tomorrow's Medicine ‫قوع‬ ‫م‬ ‫وس‬ ‫ه‬ َ ‫هللا‬ ‫ل‬ ‫ص‬ ‫هللا‬ ‫رسوع‬‫آدن‬ ‫نأل‬ ‫نا‬،‫بطن‬ ‫نن‬ ‫شرا‬ ‫وَاء‬‫قنن‬ ‫أكَلت‬ ‫آدم‬ ‫ابن‬ ‫بحسب‬ ‫به‬ ‫ص‬‫لنفسه‬ ‫ث‬ ‫وث‬ ‫لشرابه‬ ‫ث‬ ‫وث‬ ‫لطعانه‬ ‫ث‬ ‫فث‬ ‫نحالة‬ ‫َل‬ ‫كان‬ ‫فإن‬ ،. ‫رواه‬‫ي‬ ‫الترن‬‫وصححه‬‫اْللبان‬ Messenger of Allah ( ‫ﷺ‬) say: "No man fills a container worse than his stomach. A few morsels that keep his back upright are sufficient for him. If he has to, then he should keep one-third for food, one-third for drink and one-third for his breathing.“ [At-Tirmidhi]. ‫هللا‬ ‫ل‬ ‫ص‬ ‫هللا‬ ‫رسوع‬ ‫م‬ ‫وس‬ ‫ه‬ َ
  • 62. Main references: How epigenetics, our gut microbiome and the environment interact to change our lives Ben Locwin | Genetic Literacy Project | October 17, 2016 Health and the Gut Microbiome: Restoring a Lost Legacy Mark Pettus MD. Director of Medical Education and Population Health. Berkshire Health Systems. March 27, 2017 The Fungal Mycobiota: Small Numbers, Large Impacts Carol A. Kumamoto1,* 1Department of Molecular Biology and Microbiology, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA *Correspondence: carol.kumamoto@tufts.edu http://dx.doi.org/10.1016/j.chom.2016.05.018 Fungal dysbiosis: immunity and interactions at mucosal barriers Iliyan D. Iliev 1,2,3 and Irina Leonardi 1,3 Nat Rev Immunol. 2017 Oct; 17(10): 635–646. Published online 2017 Jun 12. doi: 10.1038/nri.2017.55 The Fungal Mycobiome and Its Interaction with Gut Bacteria in the Host Qi Hui Sam 1 ,Matthew Wook Chang 2,3 Int. J. Mol. Sci. 2017, 18(2), 330; doi:10.3390/ijms18020330 Systemic candidiasis Other Names: Systemic candida infections; Invasive Candidiasis Genetic and Rare Diseases Information Center (GARD)
  • 63. Role of intestinal microbiota and metabolites on gut homeostasis and human diseases Lan Lin1*Lin and Zhang BMC Immunology (2017) 18:2 DOI 10.1186/s12865-016-0187-3 Immunological Consequences of Intestinal Fungal Dysbiosis Matthew L. Wheeler,1 Jose J. Limon,1 Agnieszka S. Bar,1,6 Christian A. Leal,1 Matthew Gargus,1 Jie Tang,2 Jordan Brown,2 Vincent A. Funari,2 Hanlin L. Wang,3 Timothy R. Crother,4 Moshe Arditi,4 David M. Underhill,1,3,5,* and Iliyan D. Iliev1,5,6,* The Mycobiome: A Neglected Component in the Microbiota-Gut-Brain Axis Raphaël Enaud 1,2,3,*, Louise-Eva Vandenborght 1,3,4, Noémie Coron 1,2,3, Thomas Bazin 1,2, enaud Prevel 1, Thierry Schaeverbeke 1,2, Patrick Berger 1,2,3, Michael Fayon 1,2,3, Thierry Lamireau 1,2 ID and Laurence Delhaes 1,2,3 Received: 5 February 2018; Accepted: 5 March 2018; Published: 9 March 2018 Role of the gut microbiota in nutrition and health Article (PDF Available) in BMJ Clinical Research 361:k2179 · June 2018 with 286 Reads DOI: 10.1136/bmj.k2179 JB Review J Biochem 127, 717-722 2000: The Function of Vitamin D Receptor in Vitamin D Action Shigeaki Kato Institute of Molecular and Cellular Biosciencex The University of Tokyo, Yavoi- cho, Bunkyo-ku, Tokyo, 113-0032; and CREST, Japan Science and Technology Corporation, 41-8 Honcho, Kawaguchi, Saitama 332 Received January 21, 2000; accepted January 28, 2000

Editor's Notes

  1. Intact microbiome is essential for many aspects of the development of the GIT including – the mucosa associated immune system, immune tolerance, epithelial and barrier function, motility and vascularity. the resident commensal microbiota continues to contribute to such homeostatic functions such as pathogen exclusion, immunomodulation, upregulation of cytoprotective genes, prevention and regulation of apoptosis and maintenance of barrier function