Monday, November 10, 2014

Intestinal Parasites: Friends, Foes and Shades of Gray


Parasite is a bad word with negative connotations. Yet, "bad things" can be good for you - and every situation is different.

About one third of people in the world carry at least one parasite in their gastrointestinal tract (the numbers reported vary from 2-4% in Japanese residing in developing countries to 6% in patients of a specialized private hospital in Saudi Arabia, 7% among individuals with mental retardation in New York, 17% in HIV patients with low CD4 counts in France, 30% in households of USA, Saudi Arabia and Turkey, 40% in Pakistan and Brasil, to over 50% in Nigeria, 50-70% in Morocco and almost 100% in Senegal). Prevalence varies between countries and within communities. Women and children appear to harbor larger numbers of parasites. But men, in general, may be less healthy than women, so the relationship between health and intestinal parasites is not as straightforward as one might think.

Let's take a look at three studies published this year.

Paper by Lukeš and co-authors (2014) suggests that intestinal parasites such as Blastocystis (single celled protozoa closely related to algae and molds) and nematodes (e.g., tapeworms or hookworms) can be actually beneficial to human health. To prove the point, Julius Lukeš even ingested  a handful of tapeworms called Diphyllobothrium latum. After more than a year with the tapeworms, which might have grown to be as long as four meters each by now, he still feels healthy and convinced that we should rethink our views of organisms that live off our bodies.

According to a Danish study (Krogsgaard et al, 2014), Blastocystis could be rare in individuals with low microbial diversity, disturbed by antibiotic treatment, inflammation, infection and diet, while common in the healthy population. Healthy individuals are more likely to carry intestinal parasites (50% vs 36%) than those with IBS and IBD. Protozoa Blastocystis and Dientamoeba were the most common parasites found. D fragilis was detected in a greater proportion of fecal samples from controls than cases (35% vs 23%; P = .03), and so was Blastocystis (22% of controls vs 15% of cases; P = .09), and combinations of parasite species (16% of controls vs 8% of cases; P = .05). D fragilis infection was more likely among those with low frequency of defecation and those having children 5 to 18 years old in the household. Blastocystis was associated with high income, increasing age, no animals in the household and drinking bottled water. These results are drawn from analyzing hundreds of individuals - 124 cases/204 controls.

Smaller and more focused studies, however, do find association between Blastocystis and IBS.

A recent French study compared the prevalence of Blastocystis among 56 IBS patients and  56 control and found that Blastocystis species are likely to couse IBS symptoms in men (prevalence was 37% in IBS sufferers vs 5% in healthy men; difference in women was not statistically significant). One of the older smaller studies that indicated possible relation between Blastocytes and IBS (Funda Dogruman-Al et al., 2009) suggested that Blastocystis don't really attack the body, it's the human organism that attacks the microbes first and the outcome is the result of defensive actions by the microbes. Obviously, symptoms do depend on many other health factors. Nourrisson and co-authors identified them as the prevalence of certain "good" bacteria. Men are more likely to get constipated when their Blastocystis leads to a significant decrease in Bifidobacterium species. On the other hand, they are doing just fine if Blastocystis causes decrease in Faecalibacterium prausnitzii - relatively good bacteria known for its anti-inflammatory properties,

Another interesting insight into the impact of a complex interplay of environmental factors on our health. Still a long way to go to understand how we interact with microbes that call us home.


REFERENCES

Lukeš J, Kuchta R, Scholz T, & Pomajbíková K (2014). (Self-) infections with parasites: re-interpretations for the present. Trends in parasitology, 30 (8), 377-85 PMID: 25033775
press release

Krogsgaard LR, Engsbro AL, Stensvold CR, Nielsen HV, & Bytzer P (2014). The Prevalence of Intestinal Parasites Is Not Greater Among Individuals With Irritable Bowel Syndrome: a Population-Based Case-Control Study. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association PMID: 25229421

Nourrisson C, Scanzi J, Pereira B, NkoudMongo C, Wawrzyniak I, Cian A, Viscogliosi E, Livrelli V, Delbac F, Dapoigny M, & Poirier P (2014). Blastocystis Is Associated with Decrease of Fecal Microbiota Protective Bacteria: Comparative Analysis between Patients with Irritable Bowel Syndrome and Control Subjects. PloS one, 9 (11) PMID: 25365580

El Safadi D, Gaayeb L, Meloni D, Cian A, Poirier P, et al. (2014) Children of Senegal River Basin show the highest prevalence of Blastocystis sp. ever observed worldwide. BMC Infect Dis 14: 164 doi:10.1186/1471-2334-14-164.

Boorom KF, Smith H, Nimri L, Viscogliosi E, Spanakos G, Parkar U, Li LH, Zhou XN, Ok UZ, Leelayoova S, Jones MS: (2008) Oh my aching gut: irritable bowel syndrome, Blastocystis, and asymptomatic infection. Parasit Vectors, 1:40 2

Krogsgaard LR, Engsbro AL, & Bytzer P (2013). The epidemiology of irritable bowel syndrome in Denmark. A population-based survey in adults ≤50 years of age. Scandinavian Journal of Gastroenterology, 48 (5), 523-9 PMID: 23506174

(2004) Intestinal parasites prevalence and related factors in school children, a western city sample--Turkey. BMC Public Health. 2004 Dec 22;4:64.

Houmsou R.S., Amuta E.U., Olusi T.A. (2010) Prevalence of intestinal parasites among primary school children in Makurdi, Benue State- Nigeria. Internet Journal of Infectious Diseaes. vol.8, 1, p.2

Schupf N, Ortiz M, Kapell D, Kiely M, Rudelli RD. Prevalence of intestinal parasite infections among individuals with mental retardation in New York State. Ment Retard. 1995 Apr;33(2):84–8

Sah, Ram; Bhattarai, Sailesh; Yadav, Satish; Baral, Ratna; Nilambar; Pokharel, Paras (2013) A study of prevalence of intestinal parasites and associated risk factors among the school children of Itahari, Eastern Region of Nepal. Tropical Parasitology, 3, 2, 140-144, DOI 10.4103/2229-5070.122143

Oman Med J. May 2011; 26(3): 182–185. doi: 10.5001/omj.2011.44 PMCID: PMC3191688 Dina AM Zaglool,1 Yousif AW Khodari,2 Zohair J. Gazzaz,3 Khalid O. Dhafar,4 Hani AS Shaker,5 and Mian U. Farooq
nt J Infect Dis. 2012 Sep;16(9):e677-9. doi: 10.1016/j.ijid.2012.05.1022. Epub 2012 Jul 6.

Prevalence of opportunistic intestinal parasitic infections among HIV-infected patients with low CD4 cells counts in France in the combination antiretroviral therapy era. Pavie J1, Menotti J, Porcher R, Donay JL, Gallien S, Sarfati C, Derouin F, Molina JM.

Jeevitha Dhanabal, Pradeep Pushparaj Selvadoss, and Kanchana Muthuswamy (2014) Comparative Study of the Prevalence of Intestinal Parasites in Low Socioeconomic Areas from South Chennai, India. Journal of Parasitology Research Volume 2014 (2014), Article ID 630968, 7 pages http://dx.doi.org/10.1155/2014/630968

Blagburn BL1, Schenker R, Gagne F, Drake J.(2008) Vet Ther. 2008 Fall;9(3):169-75. Prevalence of intestinal parasites in companion animals in Ontario and Quebec, Canada, during the winter months.

Hamada A1, Okuzawa E, Kawabuchi Y, Nishikawa T. (1998) Kansenshogaku Zasshi. 1998 Dec;72(12):1283-8. [Prevalence of intestinal parasites among Japanese residents in developing countries]. [Article in Japanese]

Hirata, T., Nakamura, H., Kinjo, N., Hokama, A., Kinjo, F., Yamane, N. et al. (2007) Prevalence of Blastocystis hominis and Strongyloides stercoralis infection in Okinawa, Japan. Parasitol Res 101: 17171719.

Javed Yakoob, Wasim Jafri, Nadim Jafri, Rustam Khan, Muhammad Islam, M. Asim Beg, and Viqar Zaman (2004) Irritable bowel syndrome: in search of an etiology: role of Blastocystis hominis Am. J. Trop. Med. Hyg., 70(4), pp. 383–385

Monday, February 3, 2014

Digestive Diagnostics: Portable, Wearable, Insideable

Next sensors will be in you, said a recent popular article. And some of them will monitor your digestive system.

Accurate monitoring of digestion is hard. There are apps and high tech gadgets for that - like a fork that monitors eating speed or a watch that counts bites, but neither of them can provide a continuous and objective measures of what exactly is eaten and how it affects the digestive system.
Thanks to wonders of modern technology, cows now have a device that can monitor the effects of food on their digestive system. Well Cow bovine health monitor, an inch thick capsule almost as long as human hand, can be swallowed by a cow and measure the rumen pH and temperature within the digestive system every 15 minutes. It then transmits the data to a Bluetooth collar around the cow’s neck. This data can help to monitor the healthiness of cow's food intake, to predict its gas-forming potential in the short term, make sure it will lead to a high quality milk or prevent the development of health issues such as acidosis or infertility in the long term. The device can last between 80 to 100 days inside the cows.

A smaller vitamin-sized device (1mm x 26mm with weight less than 4 grams) was recently approved for use in humans. This ingestible pill camera - PillCamSB -  can monitor pressure, pH and temperature, gastrointestinal motility, lesions, ulcers, early signs of tumors and bleeding within the small bowel. FDA approved it for patients who have experienced an incomplete colonoscopy, as its lower-resolution-imaging can't completely replace the procedure.

Food we eat and drugs we take can communicate from our insides too - Ingestible Event Maker sensor - size of a grain of sand - can be attached to any pill or a food item.

Perhaps in the future we could rely on "insideables" to monitor our diet and automatically generate recommendations on what to eat and what to avoid?

According to a song, The Future's So Bright Gotta Wear Shades.

REFERENCES

Kiourti, Asimina. (2014). Implantable and ingestible medical devices with wireless telemetry functionalities: A review of current status and challenges. Bioelectromagnetics, 35 (1), 1-15 DOI: 10.1002/bem.21813

Hoskins, S.; Sobering, T.; Andresen, D.; Warren, S. (2009). Near-field wireless magnetic link for an ingestible cattle health monitoring pill Engineering in Medicine and Biology Society, 2009. EMBC 2009. Annual International Conference of the IEEE DOI: 10.1109/IEMBS.2009.5332812

Wong WM, Bautista J, Dekel R, et al. Feasibility and tolerability of transnasal / per-oral placement of the wireless pH capsule vs. traditional 24-h oesophageal pH monitoring – a randomized trial. Aliment Pharmacol Ther. 2005; 21(2): 155-163.

Hirono I, Richter JE. Practice Parameters Committee of the American College of Gastroenterology. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007; 102(3): 668-685.

Teunissen LP, de Haan A, de Koning JJ, Daanen HA. Telemetry pill versus rectal and esophageal temperature during extreme rates of exercise-induced core temperature change. Physiol Meas. 2012 Jun;33(6):915-24. doi: 10.1088/0967-3334/33/6/915. Epub 2012 May 3.

Tuesday, October 29, 2013

IBS: pity, compassion and discrimination


The effects of IBS on quality of life may be more substantial than those of many other chronic diseases. It affects school, work and life, putting the sufferers at risk for social isolation. 

Numerous books, columns and blogs about this condition affirm that social problems arise because the sufferers are trying to hide the fact they have IBS from others. Keeping secrets is stressful, while being upfront and coming out of the closet is the best strategy. Is it really?  

Studies about emotional reactions towards people with chronic condition often lead to mixed results. 

For example, there was a slight increase in the readiness to feel pity to depressed people since the 90s, yet there was no increase in compassion.

The most important consequence of TMAU - a metabolic disorder causing an offensive body odor - is social. This condition is not a subject of compassion, but rejection and ridicule resulting in low self-esteem, social ostracizing, anxiety and depression.


Obese people (body mass index of 35 or higher - a condition that can't be hidden and kept in secret) are more likely to report day-to-day interpersonal discrimination and mistreatment. Recent study showed that weight discrimination makes people 2.5 times more obese after 4 years of discrimination instead of helping them to reduce their weight. People don't feel compassion as they consider obese individuals lazy, unsuccessful and weak-willed. 


Same can be applied to IBS.

"The hardest thing is that other people who don’t have IBS can never understand what it is like”, says a sufferer in comments to an online article. People with IBS are often discriminated and the blows to self-esteem make it harder for them to make meaningful changes to their lifestyle, and to ease the symptoms. 


Compassion is a very valuable process that motivates sufferers as well as people around them to cooperate in achieving better outcomes. Professional education  - based on visual arts and other methods -  is often recommended in developing compassionate physicians, dietitians and nurses. But shouldn't we teach society as a whole to be non-judgemental, treating sufferers of chronic conditions with respect and compassion? And what should those with chronic illness do in the current society? 


Don't view your condition as a weakness and  - when you need to tell others about it - keep it unemotional. People don't like sob stories, no matter how true or heartbreaking they are. Don't look for pity, impress them with your strength. Be able to tell the difference between a joke and bullying. Have a laugh with them and try to find better job environments and people that care.




REFERENCES

Sutin AR, & Terracciano A (2013). Perceived weight discrimination and obesity. PloS one, 8 (7) PMID: 23894586

Angermeyer MC, & Matschinger H (2004). Public attitudes to people with depression: have there been any changes over the last decade? Journal of affective disorders, 83 (2-3), 177-82 PMID: 15555711

Bray L, O'Brien MR, Kirton J, Zubairu K, & Christiansen A (2013). The role of professional education in developing compassionate practitioners: A mixed methods study exploring the perceptions of health professionals and pre-registration students. Nurse education today PMID: 23880325

Sunday, June 9, 2013

Is Your Work Giving you IBS?

All jobs come with health risks. Some risks are obvious in the short-term, others seem very minor but with plenty of negative long-term consequences. Such as weight gain or irritable bowel syndrome.

Most likely to gain weight on the job
Recent CareerBuilder report shows that employees spending long hours behind a desk or experiencing high levels of stress gain weight on the job. Chances to gain weight are 69% for administrative assistants, 56% for engineers including software developers, 51% for teachers and K-12 instructors, 51% for B14 nurse practitioners and physician assistants, 51% for IT managers and network administrators, 46% for attorneys, judges and legal professionals, 45% for operators, assembly line and production workers and 39% for biological, physical and social scientists.


Irritable Bowel Syndrome is also associated with stressful, sedentary and less regular lifestyles. Some studies showed that this common disorder is more prevalent among the unemployed, those with lower income and education. But this could be a consequence rather than the cause. As IBS is more likely to occur in teenagers and singles (or stressed heads of households) under the age of 40. And the younger the person, the more it affects the social functioning, making it more difficult to get higher education, employment and advance career.

Studies all over the world showed that students are among the most vulnerable to IBS populations. The risk of getting it is 30% or higher. High stress, irregular schedules and lousy diets are a way of life for most students. Attending a university or college is a stressful experience, indeed. IBS flareups, however, do not directly correlate with stress per se, rather with the perceived stress. A study that looked at military veterans, for example, found that those who developed IBS had twice higher rates of anxiety and depression than other veterans. Female veterans suffering from posttraumatic stress disorder had 3-9 times higher rate of IBS. Prevalence of IBS in female veterans was about 40%, higher than for students. Rates of IBS among another stressful profession - nursing - are about the same as for students. But rates for rotating shift nurses can be as high as almost 50% - even higher than for military personnel.

So, if you want to avoid IBS, become a dietitian - it's one of the least stressful jobs with fixed hours and opportunities to think about healthy food choices. Or be your own Aurametrix, to find what foods, activities and environmental exposures work best for you - and in what amounts and combinations.

REFERENCES

Kim HI, Jung SA, Choi JY, Kim SE, Jung HK, Shim KN, & Yoo K. (2013) Impact of shiftwork on irritable bowel syndrome and functional dyspepsia. Journal of Korean medical science, 28(3), 431-7. PMID: 23487413

Nojkov B, Rubenstein JH, Chey WD, & Hoogerwerf WA (2010). The impact of rotating shift work on the prevalence of irritable bowel syndrome in nurses. The American journal of gastroenterology, 105 (4), 842-7 PMID: 20160712

Okami, Y. (2013). Irritable bowel syndrome in Chinese nursing and medical school students—Related lifestyle and psychological factors Open Journal of Gastroenterology, 03 (01), 55-63 DOI: 10.4236/ojgas.2013.31009

Jafri W, Yakoob J, Jafri N, Islam M, & Ali QM. (2005) Frequency of irritable bowel syndrome in college students. Journal of Ayub Medical College, Abbottabad : JAMC, 17(4), 9-11. PMID: 16599025

Naeem SS, Siddiqui EU, Kazi AN, Memon AA, Khan ST, & Ahmed B. (2012) Prevalence and factors associated with irritable bowel syndrome among medical students of Karachi, Pakistan: a cross-sectional study. BMC research notes, 255. PMID: 22624886

Alhazmi AH. (2011) Irritable bowel syndrome in secondary school male students in AlJouf Province, north of Saudi Arabia. JPMA. The Journal of the Pakistan Medical Association, 61(11), 1111-5. PMID: 22125990

Dong YY, Zuo XL, Li CQ, Yu YB, Zhao QJ, & Li YQ. (2010) Prevalence of irritable bowel syndrome in Chinese college and university students assessed using Rome III criteria. World journal of gastroenterology : WJG, 16(33), 4221-6. PMID: 20806442

Hazlett-Stevens H, Craske MG, Mayer EA, Chang L, & Naliboff BD. (2003) Prevalence of irritable bowel syndrome among university students: the roles of worry, neuroticism, anxiety sensitivity and visceral anxiety. Journal of psychosomatic research, 55(6), 501-5. PMID: 14642979

Olubuyide IO, Olawuyi F, & Fasanmade AA. (1995) A study of irritable bowel syndrome diagnosed by Manning criteria in an African population. Digestive diseases and sciences, 40(5), 983-5. PMID: 7729288

Jafri W, Yakoob J, Jafri N, Islam M, & Ali QM. (2005) Frequency of irritable bowel syndrome in college students. Journal of Ayub Medical College, Abbottabad : JAMC, 17(4), 9-11. PMID: 16599025

Gulewitsch MD, Enck P, Hautzinger M, & Schlarb AA. (2011) Irritable bowel syndrome symptoms among German students: prevalence, characteristics, and associations to somatic complaints, sleep, quality of life, and childhood abdominal pain. European journal of gastroenterology & hepatology, 23(4), 311-6. PMID: 21399505

Rev Bras Ginecol Obstet. 2013 Feb;35(2):84-9. Irritable bowel syndrome in women with chronic pelvic pain in a Northeast Brazilian city. Lessa LM, Chein MB, da Silva DS, Poli Neto OB, Nogueira AA, Coelho LS, Brito LM.

Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-721.e4. doi: 10.1016/j.cgh.2012.02.029. Epub 2012 Mar 15. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Lovell RM, Ford AC.

Dig Dis Sci. 2006 Mar;51(3):446-53. Prevalence, sociodemography, and quality of life of older versus younger patients with irritable bowel syndrome: a population-based study. Minocha A, Johnson WD, Abell TL, Wigington WC.

Tuesday, May 14, 2013

Coffee: Bugs and Debugging

Coffee can bug or de-bug you - in many different ways.

It can actually energize your gut bugs. Nestlé researchers showed that for sixteen healthy adult volunteers consuming a daily dose of 3 cups of coffee during 3 weeks. This led to an increase of the metabolic activity and/or numbers of Bifidobacterium species, important probiotics in the food industry. Bifidobacteria has been long suggested to be therapeutic for the relief of intestinal disorders, including Irritable Bowel Syndrome (IBS). These microbes can crowd out the bad bacteria and fight inflammation. Does it mean coffee can alleviate IBS?

Unfortunately, no one was ever able to cure IBS with coffee. And diets lowering the amounts of bifidobacteria (like low FODMAP diet) are actually most beneficial for conditions associated with bacterial imbalance. Even though Bifidobacterium infantis 35624 was shown to help women at a dosage of 1x108 CFU  for 4 weeks (but not 10or 10CFU!) with abdominal pain, bloating, gas, diarrhea, constipation and other IBS symptoms. And B. lactis DN-173 010 helped healthy women to reduce transit time when 1010 CFU of these bacteria was taken for 10 days.
RNA-DGGE gels of fecal samples showing abundance
and/or metabolic activity of dominant bacteria
before and after
 coffee consumption
Too much of a good thing can be a problem and it's important to keep even "good" bacteria at bay. How much is too much coffee for IBS sufferers? It depends. And it varies from being able to only smell coffee (which might be enough to protect from stress and cavities) to drinking two cups per day.

Everything is relative. That's why Aurametrix computes tolerance profiles based on many different factors - time of the consumption relative to wake up and bed times, diet an hour, week and month prior to consumption, medications and supplements, activity, gender, medical history, stress levels, the weather and genetics.

General recommendation for healthy people is to limit their coffee intake to about 4 or 3 cups - for men and women respectively.  To prevent insomnia, digestive issues, a racing heart, high blood pressure, nervousness, irritability, nausea, risk of developing glaucoma and other short & long term problems. And it's best to drink coffee in the first half of the day - as caffeine's half life is 5 hours or more, longer with unhealthy diet and medical conditions (it could be up to 7 days for people with alcoholic hepatic disease!). The worse your coffee metabolism is, the less you should drink it. Genetically-slow caffeine metabolizers (individuals homozygous for the  CYP1A2*1A allele in their genes) should actually limit coffee to 1 cup or less, to reduce the risk of myocardial infarction. Rapid caffeine metabolizers with CYP1A2*1F genotype, on the other hand, could reduce their heart failure risk by moderate consumption of coffee. Coffee could help mice avoid skin cancer - but only if they are also vigorously exercising. It can prevent reoccurence of breast cancer - if you already had it and are taking tamoxifen. With the right genes, bacteria, diet, activities and the brain gut axis, moderate amounts of coffee can also decrease risks of type 2 diabetes,  depression, workplace apathy, cognitive decline, gout attacks, respiratory disease, infections, stroke, injuries and accidents.

But these are statistical averages. And you are not average. You are unique and paradoxical in your own wonderful way. Aurametrix was created to help you understand that.

What is your Coffee worth?


REFERENCES

Jaquet M, Rochat I, Moulin J, Cavin C, & Bibiloni R (2009). Impact of coffee consumption on the gut microbiota: a human volunteer study. International journal of food microbiology, 130 (2), 117-21 PMID: 19217682

Cornelis, MC et al., 2006. Coffee, CYP1A2 genotype, and risk of myocardial infarction. J. Amer. Med. Assn. 295(10):1135-1141.

Nehlig A: The neuroprotective effects of cocoa flavanol and its influence on cognitive performance. Br J Clin Pharmacol 2013, 75:716–727.

Lucas M, Mirzaei F, Pan A, Okereke OI, Willett WC, O'Reilly ÉJ, Koenen K, Ascherio A: Coffee, caffeine, and risk of depression among women. Arch Intern Med 2011, 171:1571–1578

Jin JS, Touyama M, Hisada T, Benno Y: Effects of green tea consumption on human fecal microbiota with special reference to Bifidobacterium species. Microbiol Immunol 2012, 56:729–739.

Maria Simonsson, Viktoria Söderlind, Maria Henningson, Maria Hjertberg, Carsten Rose, Christian Ingvar, Helena Jernström. Coffee prevents early events in tamoxifen-treated breast cancer patients and modulates hormone receptor status. Cancer Causes & Control, 2013; 24 (5): 929 DOI: 10.1007/s10552-013-0169-1

Tzounis X, Rodriguez-Mateos A, Vulevic J, Gibson GR, Kwik-Uribe C, Spencer JP: Prebiotic evaluation of cocoa-derived flavanols in healthy humans by using a randomized, controlled, double-blind, crossover intervention study. Am J Clin Nutr 2011, 93:62–72.

Mostofsky E, Rice MS, Levitan EB, Mittleman MA. Habitual coffee consumption and risk of heart failure: a dose-response meta-analysis.  Circ Heart Fail. 2012 Jul 1;5(4):401-5. doi: 10.1161/CIRCHEARTFAILURE.112.967299. Epub 2012 Jun 26.

Gabashvili, I. Why red beans and rice are good.. but not with coffee. Forbes, 4/30/2012