Antibiotics and Bowel Disorders

Frequent use of antibiotics can increase the risk of developing microbiome-associated diseases in all age groups.

Studies have shown that antibiotic exposure in the prenatal period and during the first 2 years of life can significantly impact the risk of developing atopic and metabolic disorders later in life. The first 6 months of life appeared to be a critical period, as this is when the microbiome is most susceptible to irreversible changes. 

Studies of older children (such as 11,000 teens and pre-teens from Finland) have found that, instead of a specific age, the frequency of antibiotic use in the two years prior to the diagnosis of autoimmune disorders, was more strongly associated with risk. Exposures to cephalosporins, macrolides, and amoxicillin-clavulanic acid throughout childhood seemed to increase the likelihood of Juvenile Arthritis (JIA). Exposures to macrolides within two years before diagnosis showed minor association with other autoimmune disorders, including type 1 diabetes (DM), autoimmune thyroiditis (AIT), JIA, and inflammatory bowel diseases (IBD)). 

An article recently accepted for publication found that frequent use of antibiotics later in life also increased the risk of IBD. This study of more than 6 million individuals followed for close to 20 years analyzed 87112328 person-years including 36017 new cases of ulcerative colitis (UC) and 16881 new cases of Crohn’s disease (CD) - two primary types of IBD with different characteristics. This risk was predominantly driven by those diagnosed with CD and was strongest within the first few months of antibiotic use. In a nationwide case–control study of individuals 16-years or older in Sweden, similar results were seen for three or more antibiotic dispensations.

The authors of the study hypothesized that antibiotics contribute to the development of IBD by modulating the intestinal microbiome, but more research is needed to fully understand the mechanism behind this association.

REFERENCES

Semeh Bejaoui, Michael Poulsen, The impact of early life antibiotic use on atopic and metabolic disorders: Meta-analyses of recent insights, Evolution, Medicine, and Public Health, Volume 2020, Issue 1, 2020, Pages 279–289, https://doi.org/10.1093/emph/eoaa039

Räisänen L, Kääriäinen S, Sund R, Engberg E, Viljakainen H, Kolho KL. Antibiotic Exposures and the Likelihood of Developing Pediatric Autoimmune Diseases: a Register-based Matched Case-control Study. (2021). DOI: 10.21203/rs.3.rs-1110501/v1

Faye AS, Allin KH, Iversen AT, et al Antibiotic use as a risk factor for inflammatory bowel disease across the ages: a population-based cohort study Gut Published Online First: 09 January 2023. doi: 10.1136/gutjnl-2022-327845

Post-COVID Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects 9-23% of the global population. While the exact cause of IBS is unknown, it is believed to be a combination of genetic, environmental, and psychological factors. One potential trigger of IBS is infectious illness. Studies have shown that between 3% and 36% of enteric infections can lead to the development of new IBS symptoms, with post-viral IBS being more transient than post-bacterial or post-protozoal IBS. Meta-analysis of published literature found that the incidence of new IBS 12 months after infection was 10.1% (95% confidence interval (CI) 7.2–14.1). The incidence appears higher after parasitic or protozoan infections at 49% compared to 13.8% after bacterial gastroenteritis.

The COVID-19 pandemic has highlighted the potential link between infections and IBS, as many patients with COVID-19 have developed gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal discomfort. In fact, infection of the GI tract is thought to trigger symptoms in approximately 15% of COVID-19 patients. Post-COVID-vaccination gastrointestinal occurrences were reported in 10–20% of cases and the risk of a disease flare in IBS and IBD patients was close to 10%. 

Persistent symptoms after SARS-COV-2 infection, known as Post-acute Sequelae of COVID-19 (PASC) or long-COVID, may occur in anywhere from 10-55% of those who have had COVID-19, New study found that the most common new diagnoses caused by Long Covid were tachycardia, followed by Postural Orthostatic Tachycardia Syndrome (POTS), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and IBS.

This chart shows the 0roportion of individuals diagnosed with various conditions by severity of mobility disability. Red are cardiopulmonary diagnoses (AF - atrial fibrillation, Blood Clot, Cardiomyopathy, Pericarditis, PE – pulmonary embolism, POTS – postural orthostatic tachycardia syndrome, Myocarditis, Tachycardia), light green are gastrointestinal (Irritable Bowel Disease, Irritable Bowel Syndrome), blue-green are neurologic diagnoses (MS – multiple sclerosis, ME – myaligic encephalomyelitis/chronic fatigue syndrome, PN – peripheral neuropathy, Stroke), and dark green are metabolic/renal diagnoses (AKD - acute kidney disease, Hyperthyroid, Hypothyroid, Type 1 Diabetes, Type 2 Diabetes). A little over 3% of IBS sufferers do not feel disabled, while over 10% are severely disabled.  

There are several risk factors for the development of PI-IBS, including female gender, previous antibiotic treatment, anxiety, depression, somatization, neuroticism, and clinical indicators of intestinal inflammation. A history of Clostridioides difficile infection (CDI) may also increase the risk of PI-IBS by up to 25%. Underlying possible mechanisms include ongoing increased permeability, abnormal serotonin metabolism, and ongoing chronic immune activation together with altered microbiota. 

REFERENCES

Chan WW, Grover M. The COVID-19 Pandemic and Postinfection Irritable Bowel Syndrome: What Lies Ahead for Gastroenterologists. Clinical Gastroenterology and Hepatology. 2022 Aug 6. 

Gabashvili IS. The Incidence and Effect of Adverse Events Due to COVID-19 Vaccines on Breakthrough Infections: Decentralized Observational Study with Underrepresented Groups. JMIR Formative Research. 2022 Nov 4;6(11):e41914. doi: 10.2196/41914. PMID: 36309347; PMCID: PMC9640199.

Ghoshal UC. Postinfection irritable bowel syndrome. Gut and Liver. 2022 May 5;16(3):331.

Lau B, Wentz E, Ni Z, Yenokyan K, Coggiano C, Mehta SH, Duggal P. Physical and mental health disability associated with long-COVID: Baseline results from a US nationwide cohort. medRxiv. 2022 Dec. 7

Lau B, Wentz E, Ni Z, Yenokyan K, Coggiano C, Mehta SH, Duggal P. Physical and mental health disability associated with long-COVID: Baseline results from a US nationwide cohort. medRxiv. 2022 Jan 1.

Nazarewska A, Lewandowski K, Kaniewska M, Rosołowski M, Marlicz W, Rydzewska G. Irritable bowel syndrome following COVID-19: underestimated consequence of infection with SARS-CoV-2. Polish archives of internal medicine.:16323.

Spiller R, Garsed K. Postinfectious irritable bowel syndrome. Gastroenterology. 2009 May 1;136(6):1979-88.

Thabane M, Marshall JK. Post-infectious irritable bowel syndrome. World journal of gastroenterology: WJG. 2009 Aug 8;15(29):3591.

 

The Health Benefits of Mung Beans: Antidiabetic, Anti-inflammatory, and More

Mung beans, also known as green gram or moong, are a type of small, green legume that are native to India and have been cultivated for thousands of years. They are a staple food in many Asian cuisines and are commonly used in traditional medicine, particularly in Ayurveda. 

Mung beans are a good source of nutrients, including protein, fiber, vitamins, and minerals. They are low in calories and fat, making them a healthy choice for people who are trying to lose weight or maintain a healthy weight. Mung beans are also much easier to digest than other legumes such as lentils and hard beans, which include pintos, black beans, and chickpeas. It is worth noting that mung beans are considered to be low FODMAP, meaning that they are generally well tolerated by people with irritable bowel syndrome (IBS) and other digestive disorders. 

One of the key health benefits of mung beans is their ability to cleanse and detoxify the body. Mung beans contain both soluble and insoluble fibers, which help to cleanse the colon and remove toxins from the body. The pasty texture of mung beans is often cited as an indicator of their cleansing properties. 

Mung beans have also been shown to have cholesterol-lowering and liver-protective effects, due to the presence of antioxidant compounds such as phenolic compounds. These legumes have been documented to ameliorate hyperglycemia, hyperlipemia, and hypertension, and prevent cancer and melanogenesis, as well as possess hepatoprotective and immunomodulatory activities.

According to the findings of one recent study, the methanolic extract of the seeds from the V. radiata (Mung Bean) plant possesses significant antidiabetic characteristics that are on par with those of the commonly used drug glibenclamide. Hence, V. radiata seems to be effective as a natural antidiabetic.

Mung beans may be helpful for people with digestive disorders. In one study, mung beans were found to improve symptoms such as abdominal pain, bloating, and diarrhea in people with IBS.  Mung bean supplementation was shown to prevent the High-Fat-Diet-induced gut microbiota dysbiosis. Mung Bean Seed Extracts (MSE) regulated the composition of gut microbiota by stimulating the growth of the beneficial bacteria Enterococcus, Ruminococcus, Blautia, and Bacteroides and decreasing the growth of the potential pathogenic bacteria Escherichia-Shigella. Similarly, qPCR showed increased numbers of Bifidobacterium, Lactobacillus, Faecalibacterium prausnitzii, and Prevotella, compared with people on a regular diet (control group). The anti-inflammatory activity of MSE was observed in LPS-stimulated THP-1 monocytes with the reduction of TNFα, IL-1β, IL-6, and IL-8 genes. mung bean seed coat extract

Finally, mung beans have been traditionally used to improve the overall health of the skin. Some people believe that consuming mung beans can help to purify the blood and reduce unpleasant body odor. It is also believed to help with chloasma - irregular brownish or blackish spots especially on the face.

References: 

Lopes LA, Martins MD, Farias LM, Brito AK, Lima GD, Carvalho VB, Pereira CF, Conde Júnior AM, Saldanha T, Arêas JA, Silva KJ. Cholesterol-lowering and liver-protective effects of cooked and germinated mung beans (Vigna radiata L.). Nutrients. 2018 Jun 26;10(7):821.

Amare YE, Dires K, Asfaw T. Antidiabetic Activity of Mung Bean or Vigna radiata (L.) Wilczek Seeds in Alloxan-Induced Diabetic Mice. Evidence-Based Complementary and Alternative Medicine. 2022 Oct 26;2022.

Charoensiddhi S, Chanput WP, Sae-Tan S. Gut Microbiota Modulation, Anti-Diabetic and Anti-Inflammatory Properties of Polyphenol Extract from Mung Bean Seed Coat (Vigna radiata L.). Nutrients. 2022 Jan;14(11):2275.

Hou D, Tang J, Huan M, Liu F, Zhou S, Shen Q. Alteration of fecal microbiome and metabolome by mung bean coat improves diet-induced non-alcoholic fatty liver disease in mice. Food Science and Human Wellness. 2022 Sep 1;11(5):1259-72.

Hou D, Yousaf L, Xue Y, Hu J, Wu J, Hu X, Feng N, Shen Q. Mung bean (Vigna radiata L.): bioactive polyphenols, polysaccharides, peptides, and health benefits. Nutrients. 2019 May 31;11(6):1238.

Kabré WJ, Dah-Nouvlessounon D, Hama F, Kohonou NA, Sina H, Senou M, Baba-Moussa L, Savadogo A. Anti-Inflammatory and Anti-Colon Cancer Activities of Mung Bean Grown in Burkina Faso. Evidence-Based Complementary and Alternative Medicine. 2022 Aug 9;2022.

d’Arc KW, Durand DN, Hama-Ba F, Abiola A, Felix G, Haziz S, Arnaud KN, Pascal T, Maximin S, Aly S, Lamine BM. Mung Bean (Vigna radiata (L.) R. Wilczek) from Burkina Faso Used as Antidiabetic, Antioxidant and Antimicrobial Agent. Plants. 2022 Jan;11(24):3556.

** Bharadwaj, P., & Kaur, H. (2013). Mung bean (Vigna radiata L. Wilczek): A review on its nutritional and functional aspects. Journal of Food Science and Technology, 50(6), 985-995. 

** Park, H. K., Kim, J. H., Lee, J. H., & Lee, Y. J. (2016). Cholesterol-lowering and liver-protective effects of mung bean sprouts and their related compounds. Food Science and Biotechnology, 25(1), 125-132. 

Lopes LA, Martins MD, Farias LM, Brito AK, Lima GD, Carvalho VB, Pereira CF, Conde Júnior AM, Saldanha T, Arêas JA, Silva KJ. Cholesterol-lowering and liver-protective effects of cooked and germinated mung beans (Vigna radiata L.). Nutrients. 2018 Jun 26;10(7):821.

** de Souza, D. S., & Nascimento, M. G. (2016). Mung beans (Vigna radiata L.) as a functional food: A review. Journal of Functional Foods, 22, 294-303.

Zhang N, Xu P, Wei X, Fan X, Li H. Traditional Chinese Medicine Diet Health and Dermatology. MEDS Public Health and Preventive Medicine. 2022 Feb 16;2(1):11-7.

IG: Special thanks to OpenAI's Assistant for their help with writing this article and suggesting the title. Note that the three double-starred references do not exist. They were generated by AI to look credible. All other references were selected from selected biomedical literature by the human author.

Microbiome in Complex Disease

An imbalance between microorganisms in human microbiome is responsible for many complex diseases. The relationship is complex. In a new review article published in the International Journal of Molecular Sciences, researchers analyzed over 24,000 scientific papers on gut microbiome in metabolic (n=6109 papers), immune (n=7434), autoimmune (n=1927), cardiovascular (n=2605), brain diseases (n=4216) and various cancers (n=5564).  Most papers were written about the role of microbiome in obesity (n=5342), while the smallest subset was about heart failure (n=261). 

Complex diseases occur due to interaction of genetic and environmental factors.

Gut microbes and their metabolites play important roles as environmental factors. The metabolites - such as short-chain fatty acids (SCFAs), the end products of fermentation of dietary fibers by the anaerobic microbes in the gut, can protect us from pathogen invasion by activating immune defense. Lactobacillus rhamnose, for example, strengthens the ability of the T cell response. Lactobacillus sakei reduces the level of serum IgE and IL4. Acinetobacter iwoffii improves respiratory hyperresponsiveness by blocking the recruitment of dendritic cells in the lungs. Lactobacillus casei ATCC334 can produce iron pigment, which plays a role in inhibiting tumor progression. Some microorganisms may be also used in the treatment of hypertension, cardiovascular and other diseases. 

Bacterial biofilms (bacterial colonies self-organized in complex structures), on the other hand, can interrupt human immune system in many harmful ways. Bacteroides fragilis biofilms are implicated in destruction of mucosal epithelium, thus promoting migration of harmful species and helping them escape body's defense mechanisms. Small metabolites such as trimethylamine oxide (TMAO) produced by some gut bacteria could induce cardiac hypertrophy and fibrosis. 

Some proteases secreted by microbes are contributing to developing diseases, such as arterial sclerosis, skin disease, enteritis and cardiovascular disease and others. M. globosa (a common skin color fungi), on the other hand, secretes proteinase MgSAP1 that rapidly hydrolyses Staphylococcus protein A (SpA) and prevents S. aureus biofilm formation, helping to maintain a healthy skin. Bacteria can also secrete amino acid-derived antibiotics to fight diseases - e.g., Clostridium scindens and C. sordellii that help to inhibit the growth of C. difficile. 

The new review discusses these and many other mechanisms in complex disease as well as potential cures and dietary interventions.

REFERENCES

Yu D, Meng X, de Vos WM, Wu H, Fang X, Maiti AK. Implications of Gut Microbiota in Complex Human Diseases. International Journal of Molecular Sciences. 2021, 22(23):12661.

Gamified Eating

Unhealthy diet is one the most important lifestyle risk factors for metabolic and physiologic changes predisposing to disease. IBS, for example, can be caused by irregular eating, physical inactivity, and quality of sleep, even though  IBS subjects usually eat more healthy foods (such as vegetables and legumes) than others. Gamification approaches to nutrition education offer advantages for preventing disease over traditional persuasion methods. Gamification might provide not only positive emotional feelings, but it also increases sense of immersion, facilitating learning. 

Yet, about half of existing apps don't improve health and wellbeing because they are not developed in a skilled way. 

What makes a diet best? What is the best diet for you? Every year US News calls health experts to rank popular diets and every year there are changes in ranking. 10 years ago,  the DASH diet beat out  Atkins, Jenny Craig, Slim-Fast and 15 others to win the crown. It was praised as the best for combating high blood pressure. This year it's number 2, after Mediterranean diet scoring high on weight loss, heart and brain health,  diabetes and cancer prevention. For dropping those extra pounds, 10 years ago Weight Watchers ranked No. 1, followed closely by Jenny Craig and the Raw Food Diet. This year i's the Flexitarean Diet. The database has 39 diets, a small fraction of existing "eating plans" built around various personalities and lifestyles. The EAT-Lancet diet is one of those not included - it tries to balance nutrition with environmental concerns. The FODMAP diet - best for IBS - is not ranked either. 

US News & World Report puts hard numbers on the common-sense belief that no diet is ideal for everybody. But finding out which diet is best for you could be a cumbersome task. Many apps exist but they are not sufficiently engaging or sufficiently good for your health. 

Health gamification research is progressing at a fast pace. Researchers are finding which elements the users of nutrition apps prefer. Food gamers like clear measurable goals, performance graphs, and progress bars, but seem to lack motivating elements found in non-nutrition apps - since digital "rewards",  "levels" and "leaderboards" are not sufficiently appealing.  And neither is counting calories, gameplay narratives and individual competition.  

Gamified nutrition apps show promise. Who'll design the perfect food game?

 

REFERENCES

Johnson D, Deterding S, Kuhn KA, Staneva A, Stoyanov S, Hides L. Gamification for health and wellbeing: A systematic review of the literature. Internet interventions. 2016 Nov 1;6:89-106.

Gabashvili IS. Why Red Beans and Rice Are Good ... But Not with Coffee, Forbes 2012, April 30. Retrieved from https://www.forbes.com/sites/ciocentral/2012/04/30/why-red-beans-and-rice-aregood-but-not-with-coffee DOI: 10.6084/m9.figshare.13600517

Berger, M. and Jung, C., 2021, January. Gamification in Nutrition Apps–Users’ Gamification Element Preferences: A Best-Worst-Scaling Approach. In Proceedings of the 54th Hawaii International Conference on System Sciences (p. 1335).

Guo YB, Zhuang KM, Kuang L, Zhan Q, Wang XF, Liu SD. Association between diet and lifestyle habits and irritable bowel syndrome: a case-control study. Gut and liver. 2015 Sep;9(5):649.

Van Asbroeck S, Matthys C. Use of Different Food Image Recognition Platforms in Dietary Assessment: Comparison Study. JMIR formative research. 2020 Dec 7;4(12):e15602.

Karkar R, Schroeder J, Epstein DA, Pina LR, Scofield J, Fogarty J, Kientz JA, Munson SA, Vilardaga R, Zia J. Tummytrials: a feasibility study of using self-experimentation to detect individualized food triggers. InProceedings of the 2017 CHI conference on human factors in computing systems 2017 May 2 (pp. 6850-6863).

Precision antibiotics

Antibiotics can effectively eliminate infection-causing bacteria, but they also perturb microbial communities in the body and this perturbation can be irreversible, depending on the individual. A new study demonstrates that the pre-treatment baseline gut microbiota is a major determinant of whether there will be complete or partial recovery, 

or whether antibiotics will shift microbiome to completely new states with little resemblance to the baseline community. This is consistent with the role of pre-treatment microbiota in determining response to fecal microbiota transplantation (FMT) and dietary interventions.

New research suggests a strong predictive role for baseline microbiota, especially when antibiotic exposure is less intense. Typically, after antibiotic-induced perturbations, composition of the gut microbiome changes from the baseline (phase 1) followed by post-antibiotic reorganization (phase 2) (original figure) - that will either bring the microbiome back to its initial state, change it slightly or change it dramatically creating a completely new microbiome. The latter is usually called a “regime shift”. A resistant community always resists perturbation, while a resilient community is able to completely recover and stabilize into a fully functional state after antibiotic treatment. 

Principal component mixed effect regression using microbiota and granular antibiotic exposure data showed that microbiota departures from baseline depend on the composition of the pre-treatment microbiota. Penalized generalized estimating equations identified 6 taxa within pre-treatment microbiota that predicted the extent of antibiotic-induced perturbations.

In the final model, 5 baseline taxa (Roseburia, Blautia, Eggerthella, a Lachnospiraceae genus, and a Clostridiales genus) predicted larger microbiota departures from baseline, and one taxon (Bacteroides) predicted larger resistance to perturbations. 

Specific Roseburia species degrade dietary fiber β-mannan, producing short-chain fatty acids such as butyrate, with numerous and profound homeostatic effects. Similarly, certain Eggerthella species have significant metabolic potential, contributing, for example, to the conversion of dietary fiber-derived lignans to bioactive compounds Antimicrobial peptides produced by certain Blautia species have been shown to confer colonization resistance against antibiotic-resistant pathogens Bacteroides might be exhibiting stabilizing effect via quorum sensing or by secreting antimicrobial compounds such as propionate.  Bacteroides fragilis has a protective effect on functional gastrointestinal disorders that are thought of as disorders of homeostatic imbalance

Next-generation precision antibiotics should be specific towards particular pathogens and their genes. They also should be tailored to the baseline host microbiome to prevent the development of functional gastrointestinal disorders. 

REFERENCES

Rashidi, A., Ebadi, M., Rehman, T.U. et al. Gut microbiota response to antibiotics is personalized and depends on baseline microbiota. Microbiome 9, 211 (2021). https://doi.org/10.1186/s40168-021-01170-2

Who is afraid of IBS?

Irritable bowel syndrome, also known as IBS, used to be a rare condition, but - due to industrialization and urbanization - it is now one of the most common disorders in the world. The term is even used figuratively, in a derogatory sense.

The numbers of new reported cases of irritable bowel syndrome kept increasing into the 21st century when they reached almost epidemic proportions. As the amount of information available on the Internet exploded, so did the web searches about IBS.  But then the disorder "came out of the closet", and google searches for "irritable bowel syndrome" started to dwindle, reaching a quarter of what they used to be at the peak. This downtrend mirrored ambulatory data (National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey) showing that by 2010, the rate of IBS-related visits decreased roughly by 37%.

Is IBS no longer a problem?

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

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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
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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

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

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.

Molehills and Mountains

If you suffer from IBS, chances are you're very considerate of others and even possibly an anxious ''catastrophizer.'' It was repeatedly concluded based on magnetic resonance imaging of the brain and psychological questionnaires -  for students and non-students, Easterners and Westerners, right-handed and left-handed individuals. In fact, IBS sufferers' anxieties are somewhere in between those of people with Crohn's disease (similar to healthy persons) and panic patients. And many IBS sufferers are convinced that social and occupational implications of their gastrointestinal symptoms are a catastrophe.

As someone once said, catastrophizing is not just about watching slow German films or reading Russian literature and feeling as though life is an intolerable and senseless joke. If practiced properly, catastrophizing could make many things go wrong and create a reality around our worries and fears. Including fears focused on the gut. Because if you believe something will go wrong, you make it go wrong.

But is it the personality that makes us susceptible to IBS or is it IBS that changes our personality? The connection between the brain and the gut is definitely bidirectional. So this question might be a chicken-and-egg problem.

Animal studies suggest that perturbations of behavior, such as stress, can alter microbial communities in the gut. Experimental perturbation of the microbial communities, in its turn, can alter behavior. Getting rid of some microbes helped mice to reduce anxiety or even become bold and adventurous (after neomycin, bacitracin, and pimaricin antibiotics were administered to timid and shy BALB/c mice), while adding new species of bacteria such as Campylobacter jejuni  made mice more cautious.

Many recent studies indicate the possibility of discovering bacteria specific for different types of IBS. But you can make your own discoveries before science does. Such as the best diet, exercise and emotional attitude to cultivate the bacteria of success.


Your result will be the last one in the table below. It might take up to 24 hrs for it to appear so please come back to see it.
Your score is represented in three dimensions:
rumination (repetitiveness of focusing on the symptoms of distress), magnification (the degree to which you tend to magnify your symptoms) and hopelessness (the despair you feel when you have abandoned hope of comfort or success).

REFERENCES


Hazlett-Stevens H, Craske MG, Mayer EA, et al. Prevalence of irritable bowel syndrome among university students: the roles of worry, neuroticism, anxiety sensitivity and visceral anxiety. J Psychosom Res 2003;55:501–505.

Ng SM, Chow KW. Symptoms catastrophizing versus social hypervigilance in irritable bowel syndrome patients. Soc Work Health Care. 2012;51(8):743-56. doi: 10.1080/00981389.2012.701001.

Hunt MG, Moshier S, Milonova M. Brief cognitive-behavioral internet therapy for irritable bowel syndrome. Behav Res Ther. 2009 Sep;47(9):797-802. Epub 2009 May 20.

Eric L. Garland, Susan A. Gaylord, Olafur Palsson, Keturah Faurot, J. Douglas Mann and William E. Whitehead Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. Journal of Behavioral Medicine, 2011, Dec. 8

Blankstein U, Chen J, Diamant NE, Davis KD. Altered brain structure in irritable bowel syndrome: potential contributions of pre-existing and disease-driven factors.
Gastroenterology. 2010 May;138(5):1783-9. doi: 10.1053/j.gastro.2009.12.043. Epub 2010 Jan 4.

Collins SM, Surette M, & Bercik P (2012). The interplay between the intestinal microbiota and the brain. Nature reviews. Microbiology, 10 (11), 735-42 PMID: 23000955

Neufeld KM, Kang N, Bienenstock J, Foster JA. Reduced anxiety-like behavior and central neurochemical change in germ-free mice. Neurogastroenterol Motil. 2011 Mar;23(3):255-64, e119. doi: 10.1111/j.1365-2982.2010.01620.x. Epub 2010 Nov 5.

Collins SM, Bercik P. The relationship between intestinal microbiota and the central nervous system in normal gastrointestinal function and disease. Gastroenterology. 2009 May;136(6):2003-14. doi: 10.1053/j.gastro.2009.01.075. Epub 2009 May 7.


Goehler LE, Park SM, Opitz N, Lyte M, Gaykema RP. Campylobacter jejuni infection increases anxiety-like behavior in the holeboard: possible anatomical substrates for viscerosensory modulation of exploratory behavior. Brain Behav Immun. 2008 Mar;22(3):354-66. Epub 2007 Oct 24.

Sullivan MJL, Bishop S, Pivik J. The Pain Catastrophizing scale: development and validation. Psychol Assess 1995;7:524–32. (the manual)

Hold the Starch?

Starch is that stuff that stiffens your shirts. It's also what most people eat for fuel. Wheat, rice, corn, oats, potatoes are all very starchy foods. Many popular diet plans call starch a second-rate food that should be avoided at all costs. No-starch and low starch diets are favored by irritable bowel communities, while former Weight Watchers, Jenny Craig and Atkins enthusiasts love the new Carb Lovers Diet praising starch. Yet, there may be something good about starch even for those with sensitive stomachs. 

Starch is a mixture of long and intermingled molecules digested with different rates and outcomes. Our bodies' response to eating starch depends on its amount and types along with our nature [1] and nurture, including intestinal microbes eating the leftovers [2].

Resistant Starch (RS), also called Functional Fiber, is a type of starch that may have beneficial physiological effects. It is further classified into four or five classes,  like RS2 in potatoes or RS3 (maltodextrin on food labels) formed when starchy foods are cooked and cooled. Resistant starch is not digested in the small intestine of healthy individuals. It is an effective prebiotic as it feeds and stimulates specific bacteria in the gut [3]. Bacteria consuming resistant starch raise levels of short-chain fatty acids (SCFA) and derivatives that can act as a source of energy [2,4] and provide other benefits like protection from inflammatory conditions of the bowel. 

Over 200 nutritional studies showed  that resistant starch increases satiety, reduces food consumption and can prevent weight regain, acting almost like exercise. It also lowered insulin levels and reduced the deposition of fat.

How much resistant starch do we need to eat?

Adults in most developed countries consume between 3-7 grams of resistant starch per day. The Carb lovers diet recommends 10-15 grams. According to an earlier Australian study [5], 20 grams per day may be even more beneficial. However, optimal levels of resistant starch in diet are very individual, depending on body weight, metabolism, microbial makeup and dietary preferences. Flatulence and belching are among potential side effects.

Resistant starch is like other types of fiber and prebiotics – everybody has their own individual threshold and every extra gram leads to production of excessive gas [6].

Fructooligosaccharides (FOS) and inulin, prebiotics selectively stimulating bacteria in the colon, usually lead to mild flatulence starting from about 10 grams per day. Isolated individuals experience discomfort even at 5 grams. 14-15 grams per day usually mark the threshold for significant increase in flatulence, stomach growling and cramping. Resistant starch may have slightly higher sensitivity thresholds [6].

Source	Total starch,  per 100 g	Resistant starch, per 100 g
Lentils	53.3	25.4
Red kidney beans	42.6	24.6
Black-eyed peas	53.9	17.7
Potato chips	29.5	4.8
Long-grained rice, parboiled	25	3.7
Spaghetti, cooked for 9 mins	22	2.9
Mashed potatoes	8.5	2.4
Boiled potatoes	15	2
White bread	46.7	1.9
Rye crisps	67.4	1.4
Puffed wheat cereal	67	1.2
Medium-grained rice, boiled	25	0.6
Spaghetti, cooked for 12 mins	22	0.9
Oatmeal (Oat porridge)	9	0.3

Understanding what amounts are right for you takes careful analysis and evaluation  Don’t forget about the digestible starch that accompanies indigestible starch. Ideally, our enzymes can efficiently break down the digestible starch into glucose, but the process is so lengthy (5-7 hours) that overload could result in more starch leaking through pores in the small intestine before it has a chance to be digested. This leads to endotoxins and an excess of methane and carbon dioxide, in addition to other metabolic end products, in your system.  

So remember:  there are different types of starch and they usually come packaged with other food components for which you might have separate sensitivities. In other words, your mileage may vary.

REFERENCES

[1] Perry GH, Dominy NJ, Claw KG, Lee AS, Fiegler H, Redon R, Werner J, Villanea FA, Mountain JL, Misra R, Carter NP, Lee C, Stone AC.   Diet and the evolution of human amylase copy number variation. Nat Genet. 2007 Oct;39(10):1256-60. Epub 2007 Sep 9.

[2] Bird AR, Conlon MA, Christophersen CT, & Topping DL (2010). Resistant starch, large bowel fermentation and a broader perspective of prebiotics and probiotics. Beneficial microbes, 1 (4), 423-31 PMID: 21831780

[3] Gray, G. Dietary fibre – from definitions to public health messages (pages 159–161). Article first published online: 13 Aug 2008 | DOI: 10.1111/j.1467-3010.2008.00702

[4] Donohoe, DR, Garge, N, Zhang, X, Sun, W, O'Connell, TM, Bunger, MK, Bultman, SJ. (2011). The Microbiome and Butyrate Regulate Energy Metabolism and Autophagy in the Mammalian Colon. Cell Metabolism 13 (5): 517–26

[5] Baghurst PA, Baghurst KI, Record SJ, Dietary fibre, non-starch polysaccharides and resistant starch – a review. Food Australia, 1996 Vol 48, No. 3:S1-S35.

[6] Brighenti F, Pellegrini N, Casiraghi MC, Testolin G (1995) In vitro studies to predict physiological effects of dietary fibre. European Journal of Clinical Nutrition 49, Suppl. 3, S81±S88

[7] Elmståhl, L.H. Resistant starch content in a selection of starchy foods on the Swedish market. European journal of clinical nutrition: 2002 Jun;56(6):500-5.