How does disruption of intestinal microflora affect health?

probiotics

prebiotics

metaprebiotics

As interest in natural treatments grows, so does the popularity of probiotics. In 2012, nearly 4 million American adults took probiotics or prebiotics, a fourfold increase from 2007. Probiotics were used in more than 50,000 hospitalizations at 139 U.S. hospitals in 2012. Last year alone, American consumers spent, an estimated $2.4 billion in nutritional supplements .

However, two studies have recently been published in which scientists from Israel question whether such widespread use of probiotics to improve overall well-being and restore intestinal microflora after antibiotic use is really advisable .

The first study showed that bacteria from probiotic microorganisms contained in a dietary supplement are not able to colonize the proper parts of the intestine , and, presumably, they can bypass the gastrointestinal tract without any effect on it. In another study, the same bacteria settled in the intestines after a course of antibiotics, but there was a delay in the restoration of its own microbiota . Both studies, conducted on healthy volunteers, were published in the journal Cell in October 2021.

The term "probiotics" means "live microorganisms that, when administered in an adequate dose, contribute to a health benefit to the host." However, some experts say any evidence of benefit, limited to a small number of indications, is controversial and often of poor quality. A 2021 Cochrane analysis found that data from 10 of 14 systematic reviews of clinical trials were insufficient to determine whether probiotics improve gastrointestinal health .

It would seem that things should be better in patients with diarrhea. Although many studies suggest that probiotic supplementation may prevent or treat antibiotic-associated diarrhea and Clostridium difficile infection, other studies (both children and adults) have shown no benefit for these conditions. The two most recent studies, published late last year in the New England Journal of Medicine, did not show the effectiveness of Lactobacillus rhamnosus probiotics in children with gastroenteritis or stomach flu.

Among scientists and practitioners using bacterial therapies, such uncertainty has "caused a great deal of confusion," says Eran Elinav, MD, PhD, a professor at the Wetzmann Institute in Rehovot, Israel, and lead author of the new study published in Cell. .

The benefits of fermented milk products

As you know, one of the main sources of beneficial bacteria for humans is fermented milk products. In stores, the choice of fermented milk products is now quite wide, and some of them are additionally enriched with bifidobacteria and lactobacilli. Is it possible to include kefir or yogurt in your diet daily without worrying about your intestinal microflora? Unfortunately no.

Firstly, many fermented milk products have a fairly long shelf life, which is achieved through sterilization and ultra-pasteurization of the product. As a result of such processes, not only harmful but also beneficial bacteria die, which significantly reduces the value of the product.

Secondly, in the production of fermented milk products, the types of bacteria that our body needs are often used, but those that are more convenient for the manufacturer to work with. For example, in the production of yoghurt, starters containing Bifidobacterium animals are actively used, which are found in small quantities in the human body and are not very characteristic of it.

If you want to eat fermented milk products that actually contain beneficial bifidobacteria and lactobacilli, then buy kefir and yoghurt with a short shelf life (no more than 5-7 days). Another option is to prepare fermented milk products at home yourself based on milk and dry starter cultures .

Probiotics for the intestines: list of drugs

The most effective probiotic preparations for normalizing microflora and combating pathological conditions of the intestine are:

1. Bifidumbacterin is available in many dosage forms: tablets, suppositories, powder, capsules, ampoules, dry and liquid mixture. The composition contains bifidobacteria in various doses. A product is used to suppress the activity of pathogenic and opportunistic microbes. Prescribed for adults and children over 3 years of age.
2. Linex - presented in the form of capsules for oral administration. The active components of the probiotic are bifidumbacteria, enterococci and lactobacilli. They promote the formation of healthy flora, provoke the production of essential vitamins, cause an acidic environment and improve the functioning of digestive enzymes.
3. ​Biosporin is a second generation drug. Contains a large number of living bacteria - up to 2 billion. Available in the form of tablets and powder for further preparation of the solution. It has a broad therapeutic effect and can be used for the treatment and prevention of intestinal disorders in adults and children.
4. ​Colibacterin is available in powder form for oral administration. The basis of the probiotic is the dry mass of live E. coli. The pharmacological effect is to fight pathogenic microbes, improve immune status and produce the body necessary vitamins, enzymes, and amino acids. The drug has a detrimental effect on Proteus, Salmonella and Staphylococcus. Intended for the treatment of adults and children.
5. Acipol is an effective probiotic in capsules for all age groups. It has a complex and healthy composition, which includes live lactobacilli and kefir grains. Taking the medicine helps restore damaged flora, activates the synthesis of important biological substances and helps improve intestinal motility, preventing constipation. The list of indications is quite large.

Any generation of probiotics must be taken correctly, it is advisable to consult your doctor first. This will help avoid negative consequences and increase the therapeutic effect of the drugs.

Fermented products

In the times of our ancestors, a significant proportion of the diet consisted of fermented foods. For the winter, sauerkraut was prepared in large quantities, cucumbers and tomatoes were salted in barrels. And this is no coincidence - sauerkraut products (and especially sauerkraut) are of great benefit to our body.

Fermentation is a cooking method based on lactic acid fermentation. Fermented foods contain lactic acid bacteria, which help maintain intestinal microflora. At the same time, lactic acid accumulates in the fermented product, which is secreted by lactic acid bacteria participating in the process and is a natural preservative.

The main thing is to prepare such products using natural fermentation, without adding vinegar and sugar.

After antibiotics

In their second study, the researchers looked at what happens in the gut when a person takes probiotics after a course of antibiotics. Twenty-one healthy volunteers were treated with broad-spectrum antibiotics (ciprofloxacin and metronidazole) for one week. They then either took the same supplement as in the first study twice daily for 4 weeks, an autologous fecal microbiota graft representing a sample of the subjects' own pre-antibiotic microbiota taken via upper gastrointestinal endoscopy, or nothing. and constituted the control group.

This time, none of the subjects taking probiotics were resistant to colonization. Antibiotics killed most of the natural microbiome, allowing exogenous strains to spread. However, this came at a cost: natural gut bacteria were restored over a longer period in the probiotic group compared to the control group. The return to baseline of host intestinal cell gene expression was also suppressed in the probiotic group during the six-month follow-up period.

Alexander Khoruts, a gastroenterologist and director of the gut microbiota medical program at the University of Minnesota, who was not involved in the study, said he was surprised that the probiotics showed any significant effect at all, even such a small one. It.

Khoruts primarily treats patients with difficult-to-treat C. difficile infections, and nearly all of his patients say they took probiotics. While he's not arguing with them, other than encouraging them to eat more fermentable foods, Khoruts says the evidence supporting the benefits of probiotics is weaker than many people think. “In my literature review (although many may disagree), I did not find any convincing evidence , at least for C. difficile infection, of any beneficial effect of taking probiotics ,” the doctor states.

One significant limitation is the apparent lack of randomized trials providing data on the safety of probiotics, a topic addressed by a systematic review presented in the Annals of Internal Medicine.

Despite the results of the Weizmann Institute of Science study, it is still unknown whether taking probiotics during or after a course of antibiotics actually slows down the restoration of the natural microbiome, and whether such disturbances can cause problems. The composition of the probiotics varies and, according to Knight, the researchers administered an extremely high dose. In addition, the study design did not include analysis of clinical outcomes.

However, long-term impairment after a course of antibiotics is associated with a number of health problems, including infections, obesity, allergies and chronic inflammation, says Elinav. In his opinion, long-term impairment caused by the probiotics his team was studying " could potentially lead to long-term side effects in individuals consuming them ."

Knight notes that the study was conducted on healthy volunteers who were administered antibiotics for research purposes only. In reality, people take antibiotics when they suffer from some disease. Will probiotics slow down the restoration of natural intestinal microflora in this case?

“This study does not address this issue at all,” Knight says. “It discusses the administration of antibiotics to healthy subjects, whose situation may be quite different from the clinical patient population.”

Khoruts believes that the harm from taking most probiotics is likely to be minimal. However, for him “this is quite enough to stop prescribing them and think about what to believe. "I believe the prescribing physician should have a healthy degree of skepticism regarding claims made regarding such products."

Plant food

It is not enough to simply receive bifidobacteria and lactobacilli with food; it is necessary that good conditions for their existence are maintained in the intestines, so that beneficial bacteria also receive nutrition. To do this, it is necessary that a person receives a sufficient amount of dietary fiber every day with food, which is found in cereals, vegetables, fruits, and legumes.

If plant foods predominate in the diet, then bifidobacteria and lactobacilli actively grow in the intestines. When protein foods predominate in the diet, bacteroides, Escherichia, Clostridia, and Proteus multiply in the intestines.

How intestinal microflora helps you lose weight

Another focus of attention of scientists and researchers is the dependence of a person’s weight on the diversity of microflora. Thus, recent research by American scientists has confirmed this fact. In the experiment, sets of gut bacteria from human twins were placed into the intestines of germ-free mice. In one set the twins were thin, in the other they were obese. Microbes taken from thin twins caused weight loss in mice, and bacteria from overweight twins caused obesity in mice. But after a while, when the mice were put in the same cage, the obese mice began to rapidly lose weight.

Scientists have made the assumption that microflora

is able to control eating habits, requiring a person to provide certain foods that will promote the growth of either pathogenic or “lean” bacteria. The best diet for some bacteria is fat and they constantly require it again and again, while others need sugar. It is on the dependence of nutritional needs and the diversity of bacteria in the intestines that scientists have put forward the theory that intestinal settlers seek to take over humans and manipulate the chemical composition of the environment for their own purposes and benefit. This, in turn, may mean manipulating our behavior (we get nervous if we don’t eat sweets) by influencing hunger centers with the help of nerve impulses, the desire to eat this or that product, for certain foods, or a feeling of disgust from certain foods .

Berries, herbs, vegetables, fruits

Our ancestors actively used berries, onions, garlic, horseradish, and herbs for food. On the one hand, all this was easy to collect in the forest or grow in the garden, but, on the other hand, it was of great value to the body. Many berries and herbs contain a lot of useful vitamins and minerals, and, in addition, help the body fight opportunistic flora.

Vegetables and herbs that inhibit the growth of opportunistic microflora

Fruits and berries that inhibit the growth of opportunistic microflora

Why is the balance of microflora disturbed?

This balance is very fragile and is easily subject to external influence. And this happens for several reasons:

• taking antibiotics
• eating disorder
• sugar and alcohol abuse
• poisoning
• taking certain hormonal medications
• diseases of the digestive system
• stress
• taking certain medications - non-steroidal anti-inflammatory drugs.

Signs of microflora disturbance

• Abnormal bowel movements - constipation, diarrhea, irregular bowel movements, bloating, colic, pain
• Disorders of the gastrointestinal tract - the appearance of heaviness, heartburn, belching, weight gain.
• Dehydration - the appearance of brittle and dry hair, nails, skin,
• Intoxication of the body - nausea, painful complexion, pimples and acne.
• The presence of an unpleasant odor when breathing, an unpleasant odor of feces
• Changes in the nervous system - fatigue, drowsiness, lack of mood, decreased performance.
• Dizziness and headaches

Antibiotics and growth hormones in products

However, even if a modern person adheres to proper nutrition, this does not mean that there will be no microflora disturbances in his body. The products we consume every day - milk, meat, eggs - contain small amounts of antibiotics and growth hormones, which are used in raising animals. These substances accumulate in the human body over time and poison it. Even in small quantities, antibiotics lead to the death of beneficial bacteria in the human body.

Side effects

Probiotics contain bacteria that would normally already be present in the body. However, some problems can arise if probiotics are taken in the hope of quickly getting rid of unpleasant symptoms that accumulate over a long period of time. Chronic diseases, immunodeficiency, hormonal disorders, long-term treatment with antibiotics can create a situation in the body where probiotics will not have a very noticeable effect. In this case, step-by-step therapy should be carried out, including various measures to eliminate symptoms and restore the microflora.

Prebiotics should be used with caution for certain gastrointestinal diseases. Prebiotics can also cause enzymatic disorders in the intestines and an osmotic effect in the liver. Abuse of food containing prebiotics may result in diarrhea, flatulence, and intestinal colic.

What to do?

If your body, despite proper nutrition, experiences intestinal dysbiosis, then you need probiotics. They contain significantly more beneficial bacteria than fermented milk products.

The drug "Bifidum BAG" contains bifidobacteria of the species B. bifidum and B. longum, which form the basis of the human intestinal microflora. The bacteria titer is 1011 – the same number of bacteria is contained in 1 ton of kefir.

“Bifidum BAG” is recommended for dysbacteriosis, during and after treatment with antibiotics, for disorders of the gastrointestinal tract, allergic diseases, and decreased immunity. "Bifidum BAG" normalizes intestinal microflora, disturbed due to unfavorable conditions.

Colonization assessment

In 2015, Elinav and his colleague Eran Segal, a computational biologist, demonstrated that the same food can have different effects on blood sugar in different people without diabetes, depending in part on the microflora their intestines.

These scientists developed a method for predicting postprandial blood glucose peaks based on a wide range of clinical and laboratory parameters, including stool microbiota. Predicted changes in blood glucose were used to develop a personalized diet to help reduce postprandial blood glucose peaks. Subsequently, this approach was registered as an innovation in the field of nutrition.

Elinav and Segal, in their latest work, suggest that the most effective means of restoring gut microflora is one that is personalized. In their new study, they, along with Zamir Halpern, chief of internal medicine at the Institute of Gastroenterology at Sourasky Medical Center in Tel Aviv, Israel, revisited key issues that they feel they did not adequately address in their previous studies. works: to what extent do probiotics colonize the human intestine and what effect do they have on it?

In the first study, nineteen healthy volunteers took either a commercially available 11-strain probiotic supplement or a placebo twice daily for 4 weeks. According to Elinav, the supplement included the 4 main genera of bacteria used in probiotics around the world.

Rather than relying solely on stool studies (which is common practice in gut microbiota studies), the researchers also examined sites throughout the gastrointestinal tract, both before and during a course of probiotics. Using colonoscopy and deep endoscopy of the upper digestive tract, the scientists collected samples of the contents and lining of the intestine, and also performed a biopsy of its tissue. The samples were then subjected to extensive genetic sequencing to determine microbiota composition, function, and gene expression of host intestinal cells.

Gut lining samples taken 3 weeks after starting a course of probiotics showed that subjects taking antibiotics could be divided into 2 camps: “susceptible” and “resistant”. Susceptible volunteers demonstrated significant levels of probiotic strains in the intestinal lining, whereas no significant colonization was detected in the intestines of resistant volunteers. Susceptible individuals also showed changes in the indigenous microbiome and gene expression profile throughout the intestine, which was not observed in resistant subjects or in the placebo group.

According to Colleen Kelly, a gastroenterologist and professor at Warren Alpert Medical School at Brown University who was not involved in the study, the work is the first to demonstrate that in some people the intestinal lining is resistant to probiotic colonization , “where all the action happens.” "

The baseline natural gut microbiome of volunteers largely determines whether they will be susceptible or resistant to probiotics. Interestingly, no such difference was found in stool samples: both susceptible and resistant subjects showed comparable amounts of probiotic bacteria, with more bacteria found in the stool of placebo-treated volunteers.

According to Elinav, these results suggest that " our current approach to probiotics is probably wrong ." This variability between individuals means that some people may benefit from taking probiotics and others may not.

This result is not surprising, said Rob K., Ph.D., director of the Innovative Microbiome at the University of California, San Diego, who was not involved in the study. He noted that different people react differently to the same foods, drugs and pathogens “This extends to beneficial organisms,” he said of the study, adding that previous work had found similar variability.

There is a general consensus among doctors and the public that ingesting “good” bacteria can crowd out “bad” bacteria and improve gut health even in a healthy person. Most clinical studies published so far on healthy volunteers have not found significant changes in gut microflora. With the publication of the Weizmann Institute of Science study, the health claims of probiotics are more controversial than ever. Kelly says, " The idea that people take probiotics just to improve their overall health may be a waste of money ."

The importance of restoring microflora

Normal intestinal microflora is a balance of beneficial and harmful bacteria that inhabit the human intestine. If harmful ones predominate, and beneficial ones are in the minority, this condition is called microflora imbalance and requires correction. This is what gastroenterologists do.

They recommend taking a stool test for dysbacteriosis and bacterial culture in case of noticeable disturbances in the intestines (bloating, diarrhea, nausea, constipation, pain, etc.).

Based on the test results, appropriate treatment is prescribed, after which the microflora is normalized and the person’s well-being improves. Normal intestinal microflora is important for the production of essential vitamins, strengthening the immune system and protecting against various diseases.

Various factors can worsen the condition of the intestinal microflora, these are:

• taking antibiotics and NSAIDs;
• passion for the Western diet (with the presence of fast foods);
• lack of fiber in the diet;
• taking painkillers;
• treatment with proton pump inhibitors;
• use of H2-histamine receptor blockers.

Some doctors believe that the intestinal environment does not need to be sterile. But harmful bacteria should make up no more than 15 percent of the total microflora. Only then will the imbalance persist.

Microflora can change depending on a person’s age, mood, well-being, climate, and season.

Microflora disturbances can cause the following diseases:

• oncology;
• asthma;
• colitis;
• autism;
• eczema;
• diabetes;
• obesity;
• multiple sclerosis;
• heart diseases.

That is why we must take care of the state of the intestinal microflora. Let's look at some useful tips on this matter.

How to restore intestinal microflora

The process of microflora restoration is not fast. It is important not only to adjust the diet, but also to actively help the body “build up” the microbiome - to choose the right drug containing pre- and probiotics.

Linex Probiologist Probifid RioFlora Immuno

Hilak Forte

Duphalac

Maxilac

Lactobalance

Bion-3

Sources

1. Yu.V. Yudina, Doctor of Medical Sciences, Prof. A.A. Korsunsky, Doctor of Medical Sciences, Prof. A.I. A minova, G.D. Abdullaeva, Doctor of Medical Sciences, Prof. A.P. Prodeus “Intestinal microbiota as a separate system of the body”, Evidence-based gastroenterology, 2021, T. 8, No. 4-5, p. 36-43.
2. Zimmerman Ya.S. Gastroenterology: a guide. – 2nd ed., revised. and additional – M.: GEOTAR-Media, 2015. – 816 p.: ill.
3. T.Yu. Demidova, K.G. Lobanova, O.Sh. Oinotkinova “Intestinal microbiota as a risk factor for the development of obesity and type 2 diabetes mellitus,” Therapeutic archive, 10, 2021.
4. Monograph edited by E.L. Nikonova and E.N. Popova "MICROBIOTA".